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General NPI Number Information
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NPI Number | 1386068476
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Entity Type | Individual
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Provider Name | NAA Y ODEN BCBA, NCSP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 4813 RIDGE RD STE 111-639
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City | DOUGLASVILLE
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State | GA
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Zip | 30134
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Country | US
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Telephone | 330-622-3766
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Fax | 404-225-1840
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Provider Business Mailing Address
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Address Line | 4813 RIDGE RD STE 111-639
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6117
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Country | US
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Telephone | 330-622-3766
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Fax | 404-225-1840
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | OH3043645
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-35830
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License Number State | GA
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