Provider Demographics
NPI:1205496577
Name:STELL, ANDREA O'NEAL (BCBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:O'NEAL
Last Name:STELL
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 1:119 OAK HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-6180
Mailing Address - Country:US
Mailing Address - Phone:770-654-8286
Mailing Address - Fax:
Practice Address - Street 1:102 MARY ALICE PARK RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2664
Practice Address - Country:US
Practice Address - Phone:443-414-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-19-36852103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst