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General NPI Number Information
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NPI Number | 1558037507
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Entity Type | Organization
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Legal Business Name | UPWARD AUTISM CENTER LLC
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 4400 BROWNSVILLE RD STE #105 #3080
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-8902
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Country | US
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Telephone | 470-333-2051
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Fax | 678-669-2694
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Provider Business Mailing Address
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Address Line | 4400 BROWNSVILLE RD STE #105 #3080
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-8902
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Country | US
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Telephone | 470-333-2051
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Fax | 678-669-2694
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Authorized Official
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Title or Position | OWNER/CENTER DIRECTOR
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Name | MRS. RAVEN THOMAS
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Credential | MS, BCBA
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Telephone | 502-338-4266
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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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