Provider Demographics
NPI:1215388046
Name:ADAMS, HOLLY MICHELLE (EDS, BCBA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 ORION DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5016
Mailing Address - Country:US
Mailing Address - Phone:404-797-7158
Mailing Address - Fax:
Practice Address - Street 1:2989 ORION DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5016
Practice Address - Country:US
Practice Address - Phone:404-797-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-19619103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst