Healthcare Provider Details

I. General information

NPI: 1912712589
Provider Name (Legal Business Name): LAMPLIGHT BEHAVIOR ANALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 HOLLY SPRINGS PKWY STE 101
HOLLY SPRINGS GA
30115-2343
US

IV. Provider business mailing address

330 GILMER FERRY RD
BALL GROUND GA
30107-2909
US

V. Phone/Fax

Practice location:
  • Phone: 202-904-6986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS C RAND
Title or Position: CHIEF CLINICAL OFFICER
Credential: MS, BCBA, LBA
Phone: 202-904-6986