Provider Demographics
NPI:1184034290
Name:JEFFERY, DANA (BCBA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:JEFFERY
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 1:2520 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8664
Mailing Address - Country:US
Mailing Address - Phone:770-953-6401
Mailing Address - Fax:770-953-6015
Practice Address - Street 1:2520 WINDY HILL RD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8664
Practice Address - Country:US
Practice Address - Phone:770-953-6401
Practice Address - Fax:770-953-6015
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1031098103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst