Individual
ELIZABETH ILLIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4920 ROSWELL RD STE 1, ATLANTA, GA 30342-2684
(470) 258-4050
Mailing address
4920 ROSWELL RD STE 1, ATLANTA, GA 30342-2684
(470) 258-4050
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/13/2023
Last updated
12/13/2023
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