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General NPI Number Information
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NPI Number | 1255096749
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Entity Type | Individual
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Provider Name | KIMBERLY ALVAREZ BS
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Gender | Female
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 3765 CRESTWOOD PKWY NW STE 472
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City | DULUTH
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State | GA
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Zip | 30096
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Country | US
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Telephone | 800-920-1927
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Fax |
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Provider Business Mailing Address
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Address Line | 505 WINDSOR BROOK LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3824
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Country | US
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Telephone | 404-453-0269
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-72969
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License Number State | GA
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