Individual
KANISHA KINTRELL GARRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
390 NONGO WAY, DALLAS, GA 30157-2201
(770) 315-8685
Mailing address
390 NONGO WAY, DALLAS, GA 30157-2201
(404) 821-7013
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-54079
GA
106S00000X
Behavior Technician
RBT-19-94854
GA
Other
Enumeration date
09/23/2020
Last updated
04/30/2024
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