Healthcare Provider Details

I. General information

NPI: 1275156762
Provider Name (Legal Business Name): ESTEFANY ESPITIA MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 APPLEWOOD DR STE 1
DALTON GA
30720-2699
US

IV. Provider business mailing address

1401 APPLEWOOD DR STE 1
DALTON GA
30720-2699
US

V. Phone/Fax

Practice location:
  • Phone: 706-280-0012
  • Fax:
Mailing address:
  • Phone: 706-280-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: