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General NPI Number Information
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NPI Number | 1538988928
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Entity Type | Individual
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Provider Name | CHANARITH BUN BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1 GLENLAKE PKWY STE 650
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City | ATLANTA
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State | GA
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Zip | 30328-3590
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Country | US
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Telephone | 678-679-2277
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Fax |
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Provider Business Mailing Address
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Address Line | 83 ERNEST BARRETT PKWY UNIT 3005
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City | MARIETTA
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State | GA
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Zip | 30066-3515
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Country | US
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Telephone | 404-401-1683
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-75506
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License Number State | GA
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