Healthcare Provider Details

I. General information

NPI: 1164369245
Provider Name (Legal Business Name): TRUENORTH BEHAVIORAL PERFORMANCE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12469 DANESFELD DR
MILTON GA
30004-6694
US

IV. Provider business mailing address

12469 DANESFELD DR
MILTON GA
30004-6694
US

V. Phone/Fax

Practice location:
  • Phone: 808-492-0929
  • 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

VIII. Authorized Official

Name: BRANDIE BUCKNER
Title or Position: BEHAVIOR ANALYST
Credential: BCBA
Phone: 808-492-0929