Individual
MRS. CHANTEL A BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1664 MARKET PLACE BLVD, CUMMING, GA 30041-7927
(470) 253-4121
Mailing address
3439 LAKE END DR, LOGANVILLE, GA 30052-5809
(470) 304-6067
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB922732
GA
Other
Enumeration date
05/18/2023
Last updated
05/18/2023
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