Provider Demographics
NPI:1497428262
Name:STUART, THOMAS (RBT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:STUART
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3780 TOWNE XING NW APT 1015
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6614
Mailing Address - Country:US
Mailing Address - Phone:770-624-4754
Mailing Address - Fax:
Practice Address - Street 1:1619 COLLINS RD NW STE 500
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-8237
Practice Address - Country:US
Practice Address - Phone:470-531-0430
Practice Address - Fax:470-408-2550
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-177830106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician