Individual
COURTNEY BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
405 BOTTESFORD DR NW, KENNESAW, GA 30144-7133
(770) 689-6364
Mailing address
405 BOTTESFORD DR NW, KENNESAW, GA 30144-7133
(770) 689-6364
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-60408
GA
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
RBT-20-114063
—
Other
Enumeration date
03/01/2020
Last updated
07/18/2022
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