| Individual | |
|
750 Franklin Gtwy Se Apt 21b750 Marietta GA 30067-7807 | |
| (334) 739-3557 | |
| Not Available |
| Full Name | Individual |
|---|---|
| Speciality | Behavior Technician |
| Location | 750 Franklin Gtwy Se Apt 21b750, Marietta, Georgia |
| Authorized Official Name and Position | Mirian Brenick (BEHAVIOR TECHNICIAN) |
| Authorized Official Contact | 3347393557 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Individual 750 Franklin Gtwy Se Apt 21b Marietta GA 30067-7810 Ph: () - | Individual 750 Franklin Gtwy Se Apt 21b750 Marietta GA 30067-7807 Ph: (334) 739-3557 |
| NPI Number | 1831927524 |
|---|---|
| Provider Enumeration Date | 07/24/2024 |
| Last Update Date | 07/30/2024 |
| Certification Date | 07/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831927524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106S00000X | Behavior Technician | (* (Not Available)) | Primary |
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