Provider Demographics
NPI:1871361980
Name:STARLIGHT BEHAVIOR ANALYSIS AND THERAPY LLC
Entity type:Organization
Organization Name:STARLIGHT BEHAVIOR ANALYSIS AND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JINGYAO
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:404-374-9386
Mailing Address - Street 1:117 LANKFORD RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1823
Mailing Address - Country:US
Mailing Address - Phone:404-374-9386
Mailing Address - Fax:
Practice Address - Street 1:117 LANKFORD RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-1823
Practice Address - Country:US
Practice Address - Phone:404-374-9386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst