Provider Demographics
NPI:1922544576
Name:BELL, JAVONGIA (BCBA)
Entity type:Individual
Prefix:
First Name:JAVONGIA
Middle Name:
Last Name:BELL
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 1:1776 CENTURY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3397
Mailing Address - Country:US
Mailing Address - Phone:678-974-2162
Mailing Address - Fax:321-593-0839
Practice Address - Street 1:501 HIGHWAY 138 SW STE 5
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3905
Practice Address - Country:US
Practice Address - Phone:321-368-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 103K00000X
GA1-18-33268103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009093700Medicaid