Provider Demographics
NPI:1427694108
Name:CHEON, GRACE (BCBA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHEON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9940 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6417
Mailing Address - Country:US
Mailing Address - Phone:678-414-6227
Mailing Address - Fax:423-490-7751
Practice Address - Street 1:55 ATLANTA ST SE STE 399
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1977
Practice Address - Country:US
Practice Address - Phone:423-490-7710
Practice Address - Fax:423-490-7750
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-16-23549103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst