Healthcare Provider Details

I. General information

NPI: 1851948574
Provider Name (Legal Business Name): EXCEPTIONALLY YOURS AUTISM AND EDUCATIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6754 GREY ROCK WAY
LITHONIA GA
30058-3077
US

IV. Provider business mailing address

PO BOX 784
LITHONIA GA
30058-0784
US

V. Phone/Fax

Practice location:
  • Phone: 678-849-0505
  • Fax:
Mailing address:
  • Phone: 678-849-0505
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBORAH SILLSP
Title or Position: CEO
Credential: PHD, LCSW
Phone: 678-849-0505