Healthcare Provider Details

I. General information

NPI: 1316454713
Provider Name (Legal Business Name): HOPE ELEN CALLIS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOPE LAURANCE BCBA

II. Dates (important events)

Enumeration Date: 01/07/2018
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DODD ST SE STE 700
MARIETTA GA
30060-2512
US

IV. Provider business mailing address

647 BRAWLEY SCHOOL RD STE 104
MOORESVILLE NC
28117-6876
US

V. Phone/Fax

Practice location:
  • Phone: 704-703-8588
  • Fax:
Mailing address:
  • Phone: 704-703-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000609
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-33152
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: