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NPI Code Detail

MEDICARE: HEAVENLY WILKINSON MA, BCBA

MEDICARE: HEAVENLY WILKINSON 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
1103K00000XBehavior Analyst1-21-48116GA

General Provider Information

NPI Number : 1851931281
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEAVENLY WILKINSON MA, BCBA
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4920 NE ROSWELL RD STE 1
Second Line :
City : ATLANTA
State : GA
Zip : 30342-2684
Country : US
Telephone Number : 470-258-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2020
Last Update Date : 07/11/2025

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