Healthcare Provider Details

I. General information

NPI: 1457105504
Provider Name (Legal Business Name): BEHAVIOR SHAPING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 BROOKHAVEN CT
ELLERSLIE GA
31807-6315
US

IV. Provider business mailing address

127 BROOKHAVEN CT
ELLERSLIE GA
31807-6315
US

V. Phone/Fax

Practice location:
  • Phone: 172-723-9120
  • Fax: 706-243-5933
Mailing address:
  • Phone: 172-723-9120
  • Fax: 706-243-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. CHIKONDI EDGAR SAIWA
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: EDD
Phone: 727-239-1209