Provider Demographics
NPI:1114474525
Name:ADAMS, ASHLEY (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 REGENCY PATH DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4168
Mailing Address - Country:US
Mailing Address - Phone:720-333-6592
Mailing Address - Fax:
Practice Address - Street 1:919 REGENCY PATH DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4168
Practice Address - Country:US
Practice Address - Phone:720-333-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0-19-9801106E00000X
GA0-19-9801106E00000X
CORBT-16-23745106S00000X
GA1-24-75344103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician