Individual
RAVEN ASHLEY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
1619 COLLINS RD NW STE 500, KENNESAW, GA 30152
(502) 338-4266
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(407) 908-7356
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-18-32530
BCBA CERTIFICATE
—
Enumeration date
09/25/2018
Last updated
10/31/2019
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