Provider Demographics
NPI:1255952776
Name:TOOTE, CHARDONNAY (BCBA)
Entity type:Individual
Prefix:
First Name:CHARDONNAY
Middle Name:
Last Name:TOOTE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HAMMOND
Mailing Address - Street 2:BLDG 16 - STE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:678-974-2162
Mailing Address - Fax:
Practice Address - Street 1:750 HAMMOND DRIVE
Practice Address - Street 2:BLDG 16 - STE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-974-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician