Provider Demographics
NPI:1760880553
Name:GARNER, VICTORIA (EDS, BCBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WATSON DR
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-1797
Mailing Address - Country:US
Mailing Address - Phone:770-883-7955
Mailing Address - Fax:770-537-1280
Practice Address - Street 1:111 WATSON DR
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-1797
Practice Address - Country:US
Practice Address - Phone:770-883-7955
Practice Address - Fax:770-537-1280
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-14-9844103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst