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General NPI Number Information
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NPI Number | 1700601663
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Entity Type | Organization
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Legal Business Name | PIVOTAL CUSP
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 101 LOVE LN
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City | WOODSTOCK
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State | GA
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Zip | 30188-4282
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Country | US
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Telephone | 478-561-0962
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 MARS HILL RD NW STE 124-411
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City | ACWORTH
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State | GA
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Zip | 30101-7127
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Country | US
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Telephone | 478-561-0962
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHENAE AMELIA MARCH
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Credential |
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Telephone | 478-561-0962
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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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