Individual
JADA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
465 WINN WAY, DECATUR, GA 30030-1753
(470) 403-2830
Mailing address
465 WINN WAY, DECATUR, GA 30030-1753
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/31/2022
Last updated
02/22/2022
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