Individual
SUMMER DENISE GHOLSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
628 AVONDALE CREEK DR, DECATUR, GA 30032-8401
(678) 643-4436
Mailing address
628 AVONDALE CREEK DR, DECATUR, GA 30032-8401
(678) 643-4436
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-49880
GA
106S00000X
Behavior Technician
RBT-16-27495
GA
Other
Enumeration date
01/04/2018
Last updated
01/05/2024
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