Healthcare Provider Details

I. General information

NPI: 1790332856
Provider Name (Legal Business Name): ANDREA FICK MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 S CHEROKEE LN STE 1400
WOODSTOCK GA
30188-4461
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 470-499-2483
  • Fax:
Mailing address:
  • Phone: 412-496-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-19-2637-187203
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: