Destany Delaine McCullors, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-20-137243 Issued in FL

Practice address

1912 Hamilton St Ste 108
Jacksonville, FL 32210-2077

Phone

(904) 752-0642

Fax

(904) 212-0929

NPI assigned

Nov 5, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Amd Counseling & Consulting, LLC

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1346996477

  Behavior Analyst

  NPD
• Proactive Life Skills LLC

  • Community/Behavioral Health Agency
  • Jacksonville, FL
  • NPI 1902331382
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1073278933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 SAINT JOHNS AVE STE 15-214",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101852",
            "telephone_number": "352-872-2852",
            "fax_number": "904-212-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 HAMILTON ST STE 108",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102077",
            "telephone_number": "904-752-0642",
            "fax_number": "904-212-0929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLORS",
        "first_name": "DESTANY",
        "middle_name": "DELAINE",
        "credential": "RBT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-05",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-20-137243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113301300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shenita McCrimager
• Danielle E McCrone, PT
• Courtney McCullars, QASP
• Taylor McCullers
• Susan McCulloch, LCSW
• Abigail McCullough, MS, LMHC
• Cornelia M. McCullough, ARNP
• Deanna C McCullough, M.D.
• Elizabeth McCullough, M.D.
• Franklin Paul McCullough, IDC

• Behavior Technician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.