Provider Demographics
NPI:1053666891
Name:CHANDLER, HEATHER M (BCBA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:CHANDLER
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 1:1200 LAKE CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2829
Mailing Address - Country:US
Mailing Address - Phone:334-202-8941
Mailing Address - Fax:
Practice Address - Street 1:1200 LAKE CHARLES DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2829
Practice Address - Country:US
Practice Address - Phone:334-202-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-06-2955103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst