Provider Demographics
NPI:1467341677
Name:QUIRINDONGO, JESICA RAQUEL (BCBA)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:RAQUEL
Last Name:QUIRINDONGO
Suffix:
Gender:X
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2987
Mailing Address - Country:US
Mailing Address - Phone:202-445-9042
Mailing Address - Fax:
Practice Address - Street 1:3010 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2987
Practice Address - Country:US
Practice Address - Phone:202-445-9042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst