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General NPI Number Information
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NPI Number | 1861192072
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Entity Type | Individual
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Provider Name | JAYRESA D SASS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 6506 HILLANDALE DR
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City | NORCROSS
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State | GA
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Zip | 30092-3831
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Country | US
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Telephone | 770-823-3504
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Fax |
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Provider Business Mailing Address
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Address Line | 6506 HILLANDALE DR
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City | NORCROSS
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State | GA
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Zip | 30092-3831
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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 |
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-15-00604
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License Number State | NY
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