Provider Demographics
NPI:1801209135
Name:ANDERSON, CHRISTINA ELIZABETH (BCBA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 CHERRY BARK DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5975
Mailing Address - Country:US
Mailing Address - Phone:470-349-6677
Mailing Address - Fax:470-349-6677
Practice Address - Street 1:1200 LAKE CHARLES DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2829
Practice Address - Country:US
Practice Address - Phone:720-421-5360
Practice Address - Fax:470-288-9728
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-18-30788103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst