Individual
ELIZABETH WATHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2329 LAWRENCEVILLE HWY, LAWRENCEVILLE, GA 30044-4719
(770) 637-2001
Mailing address
1720 PEACHTREE ST. NE, UNIT 510, ATLANTA, GA 30309
(989) 397-2256
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
1-21-49910
GA
103K00000X
Behavior Analyst
7401001502
MI
247200000X
Other Technician
—
—
Other
Enumeration date
08/10/2016
Last updated
02/01/2024
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