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General NPI Number Information
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NPI Number | 1639764897
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Entity Type | Organization
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Legal Business Name | SUNCREST AUTISM CENTER LLC
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 1441 WOODMONT LN NW # 972
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 773-312-3735
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 WOODMONT LN NW # 972
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. REECE EPSTEIN
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Credential |
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Telephone | 773-312-3735
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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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