Organization
INDIVIDUAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAN BRENICK (BEHAVIOR TECHNICIAN)
(334) 739-3557
Entity
Organization
Contact information
Practice address
750 FRANKLIN GTWY SE APT 21B750, MARIETTA, GA 30067-7807
(334) 739-3557
Mailing address
750 FRANKLIN GTWY SE APT 21B, MARIETTA, GA 30067-7810
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/24/2024
Last updated
07/30/2024
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