Derrica Shavonta Anderson
Individual provider Active NPI Behavior Technician · Midland, GA
NPI 1124700976 · NPPES record last updated Aug 9, 2023
Key facts
- NPI
- 1124700976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- RBT-23-268815 (GA)
- Practice address
- 7730 Lynch Rd
Midland, GA 31820 - Phone
- (912) 385-4648
- NPI assigned
- Aug 2, 2023
- 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-23-268815 | GA | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-23-268815 | GA | Yes |
Addresses
Primary practice location
7730 Lynch Rd
Midland, GA 31820
Mailing address
7330 Lynch Rd
Midland, GA 31820-4010
Phone (912) 385-4648
Other providers in Midland, GA
- A. Noriega'S Therapy Services LLC
- Abella, LLC
- Mark U Akpan
- Jennifer Alexander
- Cynthia Dianne Avera
- Sydney Nicole Bakken
- Samantha Carol Bell
- Heather Lynn Bodrey
- Nancy Kathryn Brooks
All providers in Midland, 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 Aug 9, 2023. 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.