Organization
QILLAWASI LLC
Active
Other names
Success On The Spectrum
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRES DARGENT (CEO)
(470) 658-9610
Entity
Organization
Contact information
Practice address
2043 WEEMS RD., SUITE C2043, TUCKER, GA 30084
(470) 658-9610
Mailing address
2440 CIRCLEWOOD RD NE, ATLANTA, GA 30345-1950
(470) 658-9610
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
02/23/2022
Last updated
02/23/2022
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