Provider Demographics
NPI:1316454713
Name:CALLIS, HOPE ELEN (BCBA)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:ELEN
Last Name:CALLIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:
Other - Last Name:LAURANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:647 BRAWLEY SCHOOL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6876
Mailing Address - Country:US
Mailing Address - Phone:704-703-8588
Mailing Address - Fax:
Practice Address - Street 1:40 DODD ST SE STE 700
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2512
Practice Address - Country:US
Practice Address - Phone:704-703-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-17-33152106S00000X
AZBEH-000609103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ082286Medicaid