Provider Demographics
NPI:1649865254
Name:HOWELL, CASSIDY DAWN (RBT)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:DAWN
Last Name:HOWELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:DAWN
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3560 POLLYS BLF
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-5351
Mailing Address - Country:US
Mailing Address - Phone:470-695-8441
Mailing Address - Fax:
Practice Address - Street 1:1715 FRIENDSHIP CIR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-6917
Practice Address - Country:US
Practice Address - Phone:770-240-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician