Provider Demographics
NPI:1811494552
Name:MOSAIC AUTISM SERVICES, LLC
Entity type:Organization
Organization Name:MOSAIC AUTISM SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA-D
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:DONEHOWER
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:443-844-9013
Mailing Address - Street 1:1804 KOLORA CHASE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4905
Mailing Address - Country:US
Mailing Address - Phone:443-844-9013
Mailing Address - Fax:
Practice Address - Street 1:1804 KOLORA CHASE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4905
Practice Address - Country:US
Practice Address - Phone:443-844-9013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-11-9026103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty