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General NPI Number Information
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NPI Number | 1063053643
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Entity Type | Individual
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Provider Name | SARA MOON BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 53 PERIMETER CTR E STE 550
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City | ATLANTA
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State | GA
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Zip | 30346-2228
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Country | US
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Telephone | 770-822-9115
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Fax | 770-822-9457
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Provider Business Mailing Address
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Address Line | 4335 STEVE REYNOLDS BLVD
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City | NORCROSS
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State | GA
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Zip | 30093-3362
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Country | US
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Telephone | 470-657-5525
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Fax | 770-822-9457
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB440408
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License Number State |
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