Healthcare Provider Details

I. General information

NPI: 1649874231
Provider Name (Legal Business Name): JENNIFER JOYCE HONEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 MONTREAL RD
TUCKER GA
30084-5203
US

IV. Provider business mailing address

3167 NORTHBROOK DR
ATLANTA GA
30341-4629
US

V. Phone/Fax

Practice location:
  • Phone: 770-861-2120
  • Fax:
Mailing address:
  • Phone: 770-861-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60602
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-145433
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: