Provider Demographics
NPI:1942817077
Name:GARRETT, KANISHA KINTRELL (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KANISHA
Middle Name:KINTRELL
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 NONGO WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-2201
Mailing Address - Country:US
Mailing Address - Phone:404-821-7013
Mailing Address - Fax:
Practice Address - Street 1:3372 PEACHTREE RD NE STE 115
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1963
Practice Address - Country:US
Practice Address - Phone:404-574-6489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-19-94854106S00000X
GA1-21-54079103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician