Provider Demographics
NPI:1386015089
Name:CAMERON, KELSEY (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:CAMERON
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 1:1201 BURLEYSON RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-226-8900
Mailing Address - Fax:706-226-8905
Practice Address - Street 1:1201 BURLEYSON RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-226-8900
Practice Address - Fax:706-226-8905
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-20037103K00000X
GA1-15-20037103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst