Provider Demographics
NPI:1457915951
Name:LEVESTON, BRIANNA (BCBA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:LEVESTON
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 1:43 COMMUNITY SQUARE BLVD UNIT 1098
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-5743
Mailing Address - Country:US
Mailing Address - Phone:469-400-1424
Mailing Address - Fax:
Practice Address - Street 1:43 COMMUNITY SQUARE BLVD UNIT 1098
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-5743
Practice Address - Country:US
Practice Address - Phone:469-400-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-47505103K00000X
TX3936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst