Provider Demographics
NPI:1922621036
Name:GAMEZ, CHRISA ANN MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISA
Middle Name:ANN MARIE
Last Name:GAMEZ
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 1:205 WATERWOOD BND
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1718
Mailing Address - Country:US
Mailing Address - Phone:323-420-9235
Mailing Address - Fax:
Practice Address - Street 1:205 WATERWOOD BND
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1718
Practice Address - Country:US
Practice Address - Phone:323-420-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-41991103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1922621036Medicaid