Provider Demographics
NPI:1760130652
Name:CRABTREE, CARISSA ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ANN
Last Name:CRABTREE
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 1:4421 SHADOWOOD PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2337
Mailing Address - Country:US
Mailing Address - Phone:404-519-9676
Mailing Address - Fax:
Practice Address - Street 1:2300 LAKEVIEW PKWY STE 700
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-9066
Practice Address - Country:US
Practice Address - Phone:678-694-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB584194103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst