Provider Demographics
NPI:1649978636
Name:MORALES, INA CAROLYN (RBT)
Entity type:Individual
Prefix:
First Name:INA
Middle Name:CAROLYN
Last Name:MORALES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MADDOX RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-5268
Mailing Address - Country:US
Mailing Address - Phone:770-823-3564
Mailing Address - Fax:
Practice Address - Street 1:620 MADDOX RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-5268
Practice Address - Country:US
Practice Address - Phone:770-823-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-238701106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician