MEDICARE: MRS. ALEXIA ELAINE COLLINS 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	1-25-81697	GA

General Provider Information

NPI Number	:	1417566126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXIA ELAINE COLLINS BCBA

Provider Business Mailing Address
First Line	:	12082 N CROSSWICKS RD
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-1174
Country	:	US
Telephone Number	:	404-688-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 W CAMPBELLTON ST
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1219
Country	:	US
Telephone Number	:	770-742-0249
Fax Number	:

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

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	06/30/2025

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