Provider Demographics
NPI:1831785609
Name:FLETCHER, FAITH (BA, RBT)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 BROWNS MILL RD SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-6656
Mailing Address - Country:US
Mailing Address - Phone:267-621-8092
Mailing Address - Fax:
Practice Address - Street 1:1946 BROWNS MILL RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-6656
Practice Address - Country:US
Practice Address - Phone:267-621-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20147868106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician