Healthcare Provider Details

I. General information

NPI: 1144702655
Provider Name (Legal Business Name): SABRINA DANIELLE GROSSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CHASTAIN MEADOWS PKWY NW STE 200
KENNESAW GA
30144-5881
US

IV. Provider business mailing address

6505 SHILOH RD STE 100
ALPHARETTA GA
30005-1645
US

V. Phone/Fax

Practice location:
  • Phone: 678-648-7644
  • Fax:
Mailing address:
  • Phone: 678-648-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-62566
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: