Individual
MADISON RAGAN HOOVER RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., BCBA
Contact information
Practice address
102 MARY ALICE PARK RD STE 304, CUMMING, GA 30040-2683
(443) 414-1843
Mailing address
101 SHARON TRL, SUWANEE, GA 30024-1301
(404) 808-9945
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-73418
GA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
10/17/2019
Last updated
06/12/2024
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