Healthcare Provider Details

I. General information

NPI: 1356256580
Provider Name (Legal Business Name): OLIVE GROVE ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 MONTHAVEN TRCE
SUWANEE GA
30024-6441
US

IV. Provider business mailing address

3507 MONTHAVEN TRCE
SUWANEE GA
30024-6441
US

V. Phone/Fax

Practice location:
  • Phone: 404-667-5986
  • Fax:
Mailing address:
  • Phone: 404-667-5986
  • 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: MARIAFERNANDA SOLIS
Title or Position: BCBA
Credential: BCBA, LBA
Phone: 404-667-5986