Individual
PARKER ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
914 COLLIER RD NW APT 3204, ATLANTA, GA 30318-2576
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
0-20-11099
GA
103K00000X
Behavior Analyst
Primary
1-20-45578
GA
106S00000X
Behavior Technician
RBT-17-46751
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-17-46751
RBT
GA
Enumeration date
03/17/2020
Last updated
10/29/2020
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