Provider Demographics
NPI:1720789209
Name:JONES, MARISSA SHANNON (RBT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:SHANNON
Last Name:JONES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 BEAVERDAM RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-4013
Mailing Address - Country:US
Mailing Address - Phone:706-540-9075
Mailing Address - Fax:
Practice Address - Street 1:1565 BEAVERDAM RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30683-4013
Practice Address - Country:US
Practice Address - Phone:706-540-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-243523106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician