Healthcare Provider Details

I. General information

NPI: 1508589581
Provider Name (Legal Business Name): ANDERSON AUTISM SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 LENOX RD NE STE 750
ATLANTA GA
30326-1353
US

IV. Provider business mailing address

225 FRANKLIN RD UNIT 3214
ATLANTA GA
30342-2746
US

V. Phone/Fax

Practice location:
  • Phone: 470-682-3536
  • Fax: 470-682-3646
Mailing address:
  • Phone: 504-427-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. TIFFANY SIOBHAN ANDERSON
Title or Position: CEO
Credential: PSYD, BCBA
Phone: 504-427-8737