Bersabell Hirut Woldetsadik

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

622 Autumn Shore Dr
Lawrenceville, GA 30044-7428

Phone

(770) 865-4954

NPI assigned

Dec 17, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1629885124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 AUTUMN SHORE DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447428",
            "telephone_number": "770-865-4954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 AUTUMN SHORE DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300447428",
            "telephone_number": "770-865-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLDETSADIK",
        "first_name": "BERSABELL",
        "middle_name": "HIRUT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-17",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kisha Nichella Wise, LPN
• Brandy Wiseman, MA, LPC, NCC
• Christine Wilson Witter, FNP-C
• Esther Brooks Witter, CCC-SLP
• Gerrard Wofford
• Jillian Bailey Wolf, DO
• Mollie Rose Wolf, PA-C
• Diane Marie Wolfe, MHS, OTR/L
• James Alan Wolfe, M.D.
• Wesley Shane Wolfer, PA-C, RRT

• Behavior Technician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.