Individual
ELASIA RAVEN CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3330 CHASTAIN MEADOWS PKWY NW STE 200, KENNESAW, GA 30144-5881
(678) 648-7644
Mailing address
6505 SHILOH RD STE 100, ALPHARETTA, GA 30005-1645
(678) 648-7644
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-23-297919
GA
Other
Enumeration date
11/08/2023
Last updated
11/08/2023
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