Gracelyn Angela Depeaza
Behavior Technician in Newnan, GA. Individual provider (NPI-1).
NPI number1164097325
StatusActive
Last updated in NPPESMay 20, 2021
Details
- NPI
- 1164097325
- Entity type
- Individual (NPI-1)
- Name
- Gracelyn Angela Depeaza
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 20, 2021
- Certification date
- May 20, 2021
- Last updated
- May 20, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
2700 Highway 34 ENewnan, GA 30265-2315
Phone 470-394-0004
Mailing address
300 International Pkwy Ste 200Lake Mary, FL 32746-5028
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