Provider Demographics
NPI:1558064857
Name:MUGISHA, CHRISTELLE ARIELLE (RBT)
Entity Type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:ARIELLE
Last Name:MUGISHA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2349
Mailing Address - Country:US
Mailing Address - Phone:888-515-1793
Mailing Address - Fax:502-297-0289
Practice Address - Street 1:2000 RIVERSIDE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5926
Practice Address - Country:US
Practice Address - Phone:888-515-1793
Practice Address - Fax:502-297-0289
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-262651106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician