Provider Demographics
NPI:1578285458
Name:XU, JINGYAO MARTHA (BCBA)
Entity Type:Individual
Prefix:
First Name:JINGYAO
Middle Name:MARTHA
Last Name:XU
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3852 MIRANDA CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8670
Mailing Address - Country:US
Mailing Address - Phone:470-621-5492
Mailing Address - Fax:
Practice Address - Street 1:3852 MIRANDA CT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8670
Practice Address - Country:US
Practice Address - Phone:470-621-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-21-52806103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst