Provider Demographics
NPI:1740728427
Name:TSITSILIANOS, JACLYN MICHELLE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MICHELLE
Last Name:TSITSILIANOS
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:MICHELLE
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 WINDSOR BROOK LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3825
Mailing Address - Country:US
Mailing Address - Phone:714-830-8057
Mailing Address - Fax:
Practice Address - Street 1:635 WINDSOR BROOK LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3825
Practice Address - Country:US
Practice Address - Phone:714-830-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-25-80722103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst