Basic Information
| Provider Information | |||||||||
| NPI: | 1053649210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRICKE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | MITCHELL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MITCHELL | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | FAYE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1215 HIGHTOWER TRAIL B120 | ||||||||
| Address2: | INTERGRATED BEHAVIORAL SOLUTIONS, INC. | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667505554 | ||||||||
| FaxNumber: | 8669745999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 HIGHTOWER TRAIL B120 | ||||||||
| Address2: | INTERGRATED BEHAVIORAL SOLUTIONS, INC. | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667505554 | ||||||||
| FaxNumber: | 8669745999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.