| Southside Aba Llc | |
|
1135 Senoia Rd Tyrone GA 30290-1625 | |
| (770) 626-3044 | |
| (470) 200-2269 |
| Full Name | Southside Aba Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1135 Senoia Rd, Tyrone, Georgia |
| Authorized Official Name and Position | Christine Elaine Marrero (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7707076367 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Aba Llc 1135 Senoia Rd Tyrone GA 30290-1625 Ph: (770) 626-3044 | Southside Aba Llc 1135 Senoia Rd Tyrone GA 30290-1625 Ph: (770) 626-3044 |
| NPI Number | 1134759608 |
|---|---|
| Provider Enumeration Date | 01/23/2020 |
| Last Update Date | 01/23/2020 |
| Certification Date | 01/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134759608 | NPI | - | NPPES |
| 003218736A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
Epiphany Healthcare System, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1015 Tyrone Rd Ste 110, Tyrone, GA 30290 Phone: 770-306-3416 Fax: 770-306-3417 | |
We Are Back On Track Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1015 Tyrone Rd Ste 710, Tyrone, GA 30290 Phone: 770-468-3326 | |
Manifested Destiny Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 179 Handley Rd Ste D6, Tyrone, GA 30290 Phone: 404-819-4295 | |
Holistic International Ministries (dba, Him.,inc.) Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1015 Tyrone Rd Ste 420, Tyrone, GA 30290 Phone: 470-900-7361 | |
Kp Behaviors Options Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 Roscommon Ct, Tyrone, GA 30290 Phone: 470-776-4223 | |
My Epiphany Counseling And Consultation Services, Llc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 120 Millbrook Village Dr, Tyrone, GA 30290 Phone: 678-263-8830 Fax: 678-782-5491 |