Provider Demographics
NPI:1033670484
Name:SANCHEZ, MELISSA GISSEL (BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GISSEL
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 ROSWELL HILLS PL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3554
Mailing Address - Country:US
Mailing Address - Phone:404-369-0480
Mailing Address - Fax:478-209-9040
Practice Address - Street 1:420 ROSWELL HILLS PL
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3554
Practice Address - Country:US
Practice Address - Phone:404-369-0480
Practice Address - Fax:478-209-9040
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-1935139103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003218721HMedicaid
GA1-19-35139OtherBCBA CERTIFICATION NUMBER