Provider Demographics
NPI:1134560550
Name:ESCARCEGA, JULIE MADDOCK (MS, BCBA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MADDOCK
Last Name:ESCARCEGA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 OWENBY DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6375
Mailing Address - Country:US
Mailing Address - Phone:678-480-8119
Mailing Address - Fax:
Practice Address - Street 1:1489 OWENBY DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6375
Practice Address - Country:US
Practice Address - Phone:678-480-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-14
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-13-13954103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst