Provider Demographics
NPI:1083246748
Name:ACKERMAN, MELANIE RAYE (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:RAYE
Last Name:ACKERMAN
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 1:2140 BUFORD HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2140 BUFORD HWY STE 208
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-6124
Practice Address - Country:US
Practice Address - Phone:706-870-1331
Practice Address - Fax:678-765-6971
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-20-40593103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst