Provider Demographics
NPI:1114665833
Name:COX, KAITLYN AMANDA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:AMANDA
Last Name:COX
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 MACY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6344
Mailing Address - Country:US
Mailing Address - Phone:678-580-3997
Mailing Address - Fax:
Practice Address - Street 1:2501 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6344
Practice Address - Country:US
Practice Address - Phone:678-580-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-24-72018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst