Healthcare Provider Details

I. General information

NPI: 1609434513
Provider Name (Legal Business Name): ALEXANDRA WITHROW WEEDY M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 CANTON RD
CUMMING GA
30040-2213
US

IV. Provider business mailing address

319 CANTON RD
CUMMING GA
30040-2213
US

V. Phone/Fax

Practice location:
  • Phone: 470-239-2237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA001023
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: