Provider Demographics
NPI:1629451976
Name:BROWN, HEATHER (BCBA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BROWN
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 1:6100 VETERANS PKWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6223
Mailing Address - Country:US
Mailing Address - Phone:706-221-8966
Mailing Address - Fax:706-221-8967
Practice Address - Street 1:6100 VETERANS PKWY
Practice Address - Street 2:SUITE 11
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6223
Practice Address - Country:US
Practice Address - Phone:706-221-8966
Practice Address - Fax:706-221-8967
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA273058991103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst