| Southern Roots Aba Llc | |
|
575 Ridgemont Dr Fayetteville GA 30215-5084 | |
| (678) 967-9604 | |
| Not Available |
| Full Name | Southern Roots Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 575 Ridgemont Dr, Fayetteville, Georgia |
| Authorized Official Name and Position | Angela Christine Spencer (BCBA) |
| Authorized Official Contact | 6789679604 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Roots Aba Llc 575 Ridgemont Dr Fayetteville GA 30215-5084 Ph: (678) 967-9604 | Southern Roots Aba Llc 575 Ridgemont Dr Fayetteville GA 30215-5084 Ph: (678) 967-9604 |
| NPI Number | 1588467443 |
|---|---|
| Provider Enumeration Date | 03/28/2025 |
| Last Update Date | 03/28/2025 |
| Certification Date | 03/28/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588467443 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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