Provider Demographics
NPI:1073280574
Name:ESCOBEDO, VANESSA (RBT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ESCOBEDO
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 1:3330 CHASTAIN MEADOWS PKWY NW STE 200
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5881
Mailing Address - Country:US
Mailing Address - Phone:678-648-7644
Mailing Address - Fax:678-648-7479
Practice Address - Street 1:3330 CHASTAIN MEADOWS PKWY NW STE 200
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5881
Practice Address - Country:US
Practice Address - Phone:678-648-7644
Practice Address - Fax:678-648-7479
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-181424106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician