Provider Demographics
NPI:1255084141
Name:PARTIDO, JHERRICKA
Entity type:Individual
Prefix:
First Name:JHERRICKA
Middle Name:
Last Name:PARTIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 VENTURE WAY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8631
Mailing Address - Country:US
Mailing Address - Phone:404-988-7288
Mailing Address - Fax:
Practice Address - Street 1:2201 MOUNT ZION PKWY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3312
Practice Address - Country:US
Practice Address - Phone:855-870-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12154261103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst