Provider Demographics
NPI:1740512367
Name:GLASS, MICHELE J (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:J
Last Name:GLASS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CHRISTINA WAY
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-1383
Mailing Address - Country:US
Mailing Address - Phone:404-281-8820
Mailing Address - Fax:
Practice Address - Street 1:416 CHRISTINA WAY
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-1383
Practice Address - Country:US
Practice Address - Phone:404-281-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst