Elizabeth Wathen, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-49910 Issued in GA

Practice address

2329 Lawrenceville Hwy
Lawrenceville, GA 30044-4719

Phone

(770) 637-2001

NPI assigned

Aug 10, 2016

Reactivated

Feb 28, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Itd Group LLC

  • Developmental Therapist
  • Conyers, GA
  • NPI 1639561905

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1790239556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 PEACHTREE ST. NE",
            "address_2": "UNIT 510",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30309",
            "telephone_number": "989-397-2256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2329 LAWRENCEVILLE HWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300444719",
            "telephone_number": "770-637-2001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2008 Eastview Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300135717",
            "country_code": "US",
            "telephone_number": "678-374-3908",
            "fax_number": "678-905-1500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATHEN",
        "first_name": "ELIZABETH",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-10",
        "last_updated": "2024-02-01",
        "certification_date": "2024-01-30",
        "deactivation_date": "2022-01-04",
        "reactivation_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "7401001502",
            "primary": false
        },
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-21-49910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kennedy Washington
• Keyana Renee Washington, M.D.
• Tonita R Washington, FNP-BC
• Avery Swain Waters, MA, CCC-SLP
• Patricia Waters
• Bonnie Yvonne Watkins, PA
• Chantsy Watkins, LPC
• Deana Watkins, LPN
• Emily Watkins, CD/PCD(DONA)
• Melanie Erin Watkins, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.