Healthcare Provider Details

I. General information

NPI: 1679388003
Provider Name (Legal Business Name): IVY HOPE COLWELL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 PROGRESS RD
ELLIJAY GA
30540-5599
US

IV. Provider business mailing address

941 PROGRESS RD
ELLIJAY GA
30540-5599
US

V. Phone/Fax

Practice location:
  • Phone: 443-414-1843
  • Fax:
Mailing address:
  • Phone: 443-414-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89868
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: