Individual
KATHERINE ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2110 MOON STATION DR NW, KENNESAW, GA 30144-2759
(770) 627-2267
Mailing address
401 HERITAGE DR APT 104, CANTON, GA 30114-5697
(404) 512-3680
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-38892
GA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/08/2019
Last updated
01/07/2020
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