Individual
JERICHA MITCHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 INSPERON DR, GROVETOWN, GA 30813-0609
(706) 842-5330
(706) 842-5340
Mailing address
PO BOX 2567, AUGUSTA, GA 30903-2567
(706) 842-5330
(706) 842-5340
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-71781
GA
106S00000X
Behavior Technician
RBT-21-175847
SC
Other
Enumeration date
08/16/2021
Last updated
03/12/2024
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