Provider Demographics
NPI:1619594652
Name:BALDWIN, KRISTEN AMBER (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:AMBER
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:AMBER
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:194 TRIUMPH DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1050
Mailing Address - Country:US
Mailing Address - Phone:336-926-7731
Mailing Address - Fax:
Practice Address - Street 1:6151 DOVE FIELD CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1309
Practice Address - Country:US
Practice Address - Phone:770-609-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-20-42323103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst