Individual
BREANA GHOLSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2387 HUNTCREST WAY STE 100, LAWRENCEVILLE, GA 30043-8126
(678) 648-7644
Mailing address
350 FAIRWAY DR STE 101, DEERFIELD BEACH, FL 33441-1834
(877) 418-2978
(866) 500-2186
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-277527
GA
Other
Enumeration date
12/28/2023
Last updated
02/26/2024
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