Provider Demographics
NPI:1194155044
Name:CREATIVE PIECES BEHAVIOR ASSOCIATES
Entity type:Organization
Organization Name:CREATIVE PIECES BEHAVIOR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNEMISS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:770-508-5187
Mailing Address - Street 1:2295 TOWNE LAKE PKWY
Mailing Address - Street 2:SUITE-116-158
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5520
Mailing Address - Country:US
Mailing Address - Phone:770-508-5187
Mailing Address - Fax:180-088-3926
Practice Address - Street 1:2295 TOWNE LAKE PKWY
Practice Address - Street 2:SUITE-116-158
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5520
Practice Address - Country:US
Practice Address - Phone:770-508-5187
Practice Address - Fax:180-088-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10126103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1962835579OtherNPI