Provider Demographics
NPI:1114171832
Name:MONTGOMERY, CHRISTINE R (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:R
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WEATHERSTONE DR STE 530
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7006
Mailing Address - Country:US
Mailing Address - Phone:770-591-9552
Mailing Address - Fax:770-516-4191
Practice Address - Street 1:107 WEATHERSTONE DR STE 530
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7006
Practice Address - Country:US
Practice Address - Phone:770-591-9552
Practice Address - Fax:800-218-8249
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2359103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst