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General NPI Number Information
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NPI Number | 1437674587
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Entity Type | Organization
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Legal Business Name | DOGWOOD AUTISM SERVICES, LLC
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 5163 ROSWELL RD
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City | ATLANTA
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State | GA
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Zip | 30342-2206
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Country | US
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Telephone | 877-288-4760
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Fax | 404-600-1259
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Provider Business Mailing Address
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Address Line | 750 HAMMOND DR BUILDING 7 SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30328
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Country | US
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Telephone | 678-753-5598
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Fax |
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Authorized Official
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Title or Position | FOUNDING DIRECTOR
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Name | BROOKE EBEL
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Credential | BCBA
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Telephone | 877-288-4760
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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 |
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License Number State |
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