Healthcare Provider Details

I. General information

NPI: 1861089427
Provider Name (Legal Business Name): EDRIENNA HENDERSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 SNAPFINGER PARK DR
DECATUR GA
30035-4044
US

IV. Provider business mailing address

5280 SNAPFINGER PARK DR
DECATUR GA
30035-4044
US

V. Phone/Fax

Practice location:
  • Phone: 877-288-4760
  • Fax:
Mailing address:
  • Phone: 877-288-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80075
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14876
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: