Provider Demographics
NPI:1447758545
Name:VILLAMAR, EVELYN MARIA (BCBA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:MARIA
Last Name:VILLAMAR
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2715 RIDGE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2779
Mailing Address - Country:US
Mailing Address - Phone:347-603-4164
Mailing Address - Fax:
Practice Address - Street 1:833 HURRICANE SHOALS RD NE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4821
Practice Address - Country:US
Practice Address - Phone:833-628-8476
Practice Address - Fax:770-200-1563
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-17-28585103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst