Provider Demographics
NPI:1740025287
Name:ST.BERNARD, MARK (RBT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ST.BERNARD
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 RHINEHART RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1872
Mailing Address - Country:US
Mailing Address - Phone:470-983-5055
Mailing Address - Fax:
Practice Address - Street 1:2017 RHINEHART RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1872
Practice Address - Country:US
Practice Address - Phone:470-983-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician