Healthcare Provider Details

I. General information

NPI: 1609361773
Provider Name (Legal Business Name): DIANA C ECHEVERRIA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 SCENIC HWY N STE 101
SNELLVILLE GA
30078-6141
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 470-327-9193
  • Fax: 317-520-8200
Mailing address:
  • Phone: 323-867-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31305
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31305
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: