Individual
DONTAY ROSELLA LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3190 NORTHEAST EXPY NE, ATLANTA, GA 30341-5304
(404) 487-6005
Mailing address
14201 SAINT JAMES DR # 14201, CONYERS, GA 30094-1218
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-355021
GA
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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