Provider Demographics
NPI:1801174602
Name:PRINCE, LAURIE (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 MAJESTIC CV
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4568
Mailing Address - Country:US
Mailing Address - Phone:678-735-8288
Mailing Address - Fax:
Practice Address - Street 1:345 MAJESTIC CV
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-4568
Practice Address - Country:US
Practice Address - Phone:678-735-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-13-13924103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst