Provider Demographics
NPI:1417443250
Name:KING, SOPHIA ANICE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ANICE
Last Name:KING
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DUNWOODY PARK STE 116
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6711
Mailing Address - Country:US
Mailing Address - Phone:470-223-8123
Mailing Address - Fax:
Practice Address - Street 1:7 DUNWOODY PARK STE 116
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6711
Practice Address - Country:US
Practice Address - Phone:470-223-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10194544103K00000X
1-18-30364103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst