Individual
EMILY BROOKE LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
191 JOHN GODLEY LN, ELLABELL, GA 31308-8076
(912) 820-1830
Mailing address
607 GENTILLY RD, STATESBORO, GA 30458-5018
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-466106
GA
Other
Enumeration date
03/31/2026
Last updated
03/31/2026
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