Individual
JESSICA ELAINE WASHINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1135 SENOIA RD, TYRONE, GA 30290-1625
(770) 626-3044
Mailing address
1135 SENOIA RD, TYRONE, GA 30290-1625
(770) 626-3044
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-53168
GA
103K00000X
Behavior Analyst
1-21-53368
GA
106S00000X
Behavior Technician
RBT-19-85072
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003218736A
—
GA
Enumeration date
04/20/2020
Last updated
09/09/2021
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