Provider Demographics
NPI:1336504455
Name:HALLMON, DONTA NICOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:DONTA
Middle Name:NICOLE
Last Name:HALLMON
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:PO BOX 19525
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325-0525
Mailing Address - Country:US
Mailing Address - Phone:762-622-8360
Mailing Address - Fax:
Practice Address - Street 1:756 W PEACHTREE ST NW FL 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2378
Practice Address - Country:US
Practice Address - Phone:762-622-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-21-53225103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003259448PMedicaid
GA003259448GMedicaid