Most Relevant Information
Provider Data
| NPI Number: | 1003489394 |
| Provider Name: | ASHLEY TILLISON RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-21-176254 |
Most Important Dates
| Enumeration Date: | 07/23/2021 |
| Last Updated: | 12/09/2022 |
Provider Practice Location
2700 HIGHWAY 34 E STE 100
NEWNAN
GA
302652315
Practice Location Phone/Fax
| Phone: | 4703940004 |
| Fax: |
Provider Mailing Location
3500 DEPAUW BLVD STE 3070
INDIANAPOLIS
IN
462686135
Provider Mailing Phone/Fax
| Phone: | 8553240885 |
| Fax: | 3175208200 |