Provider Demographics
NPI:1972152122
Name:AVERA, EMILY RHODES (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RHODES
Last Name:AVERA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:GRACE
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:3623 CALVIN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7915
Mailing Address - Country:US
Mailing Address - Phone:706-940-5100
Mailing Address - Fax:762-208-7512
Practice Address - Street 1:3623 CALVIN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7915
Practice Address - Country:US
Practice Address - Phone:706-940-5100
Practice Address - Fax:706-221-5232
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-23-68627103K00000X
GARBT-19-98792106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician