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Organization

IMPACT CHILD BEHAVIORAL SERVICES ATL INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TANISHA M DACOSTA (CEO)
(206) 408-3046
Entity
Organization

Contact information

Practice address
3465 N DESERT DR, ATLANTA, GA 30344-5726
(206) 408-3046
Mailing address
3465 N DESERT DR, ATLANTA, GA 30344-5726
(206) 408-3046

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary

Other

Enumeration date
07/09/2026
Last updated
07/09/2026
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