MEDICARE: MRS. ANASTASIIA KOROVINA MA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-83636	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-25-83636	OTHER	GA	BCBA

General Provider Information

NPI Number	:	1053052787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANASTASIIA KOROVINA MA, BCBA

Provider Business Mailing Address
First Line	:	11030 JONES BRIDGE RD # 310
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-4560
Country	:	US
Telephone Number	:	678-829-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 PROFESSIONAL PKWY STE 220
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-6444
Country	:	US
Telephone Number	:	844-543-8437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	03/12/2026

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