Healthcare Provider Details

I. General information

NPI: 1467248633
Provider Name (Legal Business Name): LITTLE ACORNS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 GOLDMINE RD
GRANTVILLE GA
30220-2467
US

IV. Provider business mailing address

185 GOLDMINE RD
GRANTVILLE GA
30220-2467
US

V. Phone/Fax

Practice location:
  • Phone: 770-755-8461
  • Fax:
Mailing address:
  • Phone: 770-755-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: ALEX FISHER
Title or Position: OWNER
Credential:
Phone: 770-755-8461