Individual
HEAVEN LEIGH COUNTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
2550 EVAN TRADE CENTER DRIVE, UNIT 6, EVANS, GA 30809
(718) 215-5311
(718) 215-5311
Mailing address
2550 EVAN TRADE CENTER DRIVE, UNIT 6, EVANS, GA 30809
(706) 623-8458
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/17/2025
Last updated
04/17/2025
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