Provider Demographics
NPI:1790406957
Name:RACINE, ADRIANNA MARIE (RBT)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:MARIE
Last Name:RACINE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:ADRIANNA
Other - Middle Name:MARIE
Other - Last Name:RACINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6505 SHILOH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-1645
Mailing Address - Country:US
Mailing Address - Phone:678-648-7644
Mailing Address - Fax:
Practice Address - Street 1:6505 SHILOH RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1645
Practice Address - Country:US
Practice Address - Phone:678-648-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-284137106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician