Provider Demographics
NPI:1083322309
Name:SKORCZ, ANDREW PARKER (RBT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:PARKER
Last Name:SKORCZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 OLD LATHEMTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7023
Mailing Address - Country:US
Mailing Address - Phone:770-317-8575
Mailing Address - Fax:
Practice Address - Street 1:1000 COBB PLACE BLVD NW STE 230
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3684
Practice Address - Country:US
Practice Address - Phone:470-648-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-235925106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician