Provider Demographics
NPI:1750906822
Name:EVANS, MARISSA (BCBA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:500 SYCAMORE LN APT 307
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 SADDLE HILL RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1237
Practice Address - Country:US
Practice Address - Phone:203-558-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-22-60650103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst