Provider Demographics
NPI:1891364667
Name:HANCOCK-RAMIREZ DONALDSON, DUSTIN ALAN (BCBA)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ALAN
Last Name:HANCOCK-RAMIREZ DONALDSON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:DUSTIN
Other - Middle Name:ALAN
Other - Last Name:HANCOCK DONALDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 POINTE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 POINTE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-2755
Practice Address - Country:US
Practice Address - Phone:678-920-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-21-50851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst