Brandi Clark
Individual provider Active NPI Behavior Technician · Saint Marys, GA
NPI 1124516182 · NPPES record last updated Apr 25, 2018
Key facts
- NPI
- 1124516182
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- RBT-18-54167 (GA)
- Practice address
- 107 Industrial Dr Ste E
Saint Marys, GA 31558-4436 - Phone
- (912) 324-5012
- NPI assigned
- Apr 25, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-18-54167 | GA | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-18-54167 | GA | Yes |
Addresses
Primary practice location
107 Industrial Dr Ste E
Saint Marys, GA 31558-4436
Mailing address
10175 Fortune Pkwy Unit 903
Jacksonville, FL 32256-6755
Phone (904) 538-0713
Other providers in Saint Marys, GA
- Hannah Cassel
- Jessica Marie Cerstvik
- Andrea Lynn Chapman
- Kristy Chisowsky
- Michelle Y Christoforo
- Bryan Clark
- Frank David Clements
- Catherine Gurley Clever
- Ashleigh Lynn Cline
- Coastal Community Behavioral Health, LLC
All providers in Saint Marys, GA · Behavior Technician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.