Provider Demographics
NPI:1437674587
Name:DOGWOOD AUTISM SERVICES, LLC
Entity Type:Organization
Organization Name:DOGWOOD AUTISM SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBEL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:877-288-4760
Mailing Address - Street 1:750 HAMMOND DR
Mailing Address - Street 2:BUILDING 7 SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:678-753-5598
Mailing Address - Fax:
Practice Address - Street 1:5163 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2206
Practice Address - Country:US
Practice Address - Phone:877-288-4760
Practice Address - Fax:404-600-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty