Healthcare Provider Details

I. General information

NPI: 1225621139
Provider Name (Legal Business Name): LAPRINCES ELAINE KENNARD BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAPRINCESS ELAINE KENNARD BCBA, LBA

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SMITHTOWN RD
SUWANEE GA
30024-6559
US

IV. Provider business mailing address

4000 SMITHTOWN RD
SUWANEE GA
30024-6559
US

V. Phone/Fax

Practice location:
  • Phone: 470-665-6006
  • Fax:
Mailing address:
  • Phone: 626-549-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA002699
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: