Abbigale Clare Dehart

Individual provider Active NPI Behavior Technician · Soperton, GA

NPI 1548067846 · NPPES record last updated Feb 25, 2025

Key facts

NPI
1548067846
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
License
BACB1182292 (GA)
Practice address
131 Mustang Rd
Soperton, GA 30457-7461
Phone
(478) 331-8460
NPI assigned
Feb 25, 2025
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
BACB1182292GAMDBehavior Technician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician
Group: 193400000X SINGLE SPECIALTY GROUP
106S00000X BACB1182292 GA Yes

Addresses

Primary practice location

131 Mustang Rd
Soperton, GA 30457-7461

Mailing address

131 Mustang Rd
Soperton, GA 30457-7461
Phone (478) 331-8460

Other providers in Soperton, GA

All providers in Soperton, GA · Behavior Technician in Georgia

Sources for this page

Verify at the official NPI Registry.