Healthcare Provider Details

I. General information

NPI: 1134715444
Provider Name (Legal Business Name): ISABELLA NICOLE UNDERWOOD BCBA, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11285 ELKINS RD
ROSWELL GA
30076-1259
US

IV. Provider business mailing address

4605 SUNFLOWER CIR
CUMMING GA
30040-3309
US

V. Phone/Fax

Practice location:
  • Phone: 678-824-2145
  • Fax:
Mailing address:
  • Phone: 678-313-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73420
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: