Provider Demographics
NPI:1992464341
Name:POWELL-AVILA, MADELINE LEONORA (RBT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:LEONORA
Last Name:POWELL-AVILA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4452 IDLEWOOD PARK
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6247
Mailing Address - Country:US
Mailing Address - Phone:850-980-4024
Mailing Address - Fax:
Practice Address - Street 1:4452 IDLEWOOD PARK
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6247
Practice Address - Country:US
Practice Address - Phone:850-980-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician