Provider Demographics
NPI:1447838354
Name:THOMAS, SADE ALISHA (RBT)
Entity type:Individual
Prefix:
First Name:SADE
Middle Name:ALISHA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 GEORGIA HIGHWAY 20 SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2866
Mailing Address - Country:US
Mailing Address - Phone:770-668-6007
Mailing Address - Fax:
Practice Address - Street 1:3320 GEORGIA HIGHWAY 20 SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2866
Practice Address - Country:US
Practice Address - Phone:770-668-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician