Basic Information
| Provider Information | |||||||||
| NPI: | 1922679273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ELAIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5060 DUVAL POINT WAY SW | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300397623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1770864664 | ||||||||
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| Practice Location | |||||||||
| Address1: | LITHONIA ABA THERAPY | ||||||||
| Address2: | 5461 HILLANDALE DRIVE | ||||||||
| City: | LITHONIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4703612976 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2021 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.