NPIMap

Organization Active NPI

Kicklighter Resource Center

  • Behavior Analyst
  • Savannah, GA
National Provider Identifier
1689802779
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
KICKLIGHTER RESOURCE CENTER
Practice address
7219 Seawright Dr
Savannah, GA 31406-2703
Phone
(912) 355-7633
Fax
(912) 355-4206
NPI assigned
Jun 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Authorized official

Name
Stacey Davis
Title
Ceo/Executive Director
Phone
(912) 355-7633

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

7219 Seawright Dr
Savannah, GA 31406-2703

Mailing address

PO Box 13625
Savannah, GA 31416-0625
Phone (912) 355-7633

National Provider Directory

National Provider Directory

Locations

7219 Seawright Dr
Savannah, GA 31406
Phone (912) 355-7633

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1689802779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13625",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314160625",
            "telephone_number": "912-355-7633",
            "fax_number": "912-355-4206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7219 SEAWRIGHT DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314062703",
            "telephone_number": "912-355-7633",
            "fax_number": "912-355-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKLIGHTER RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-26",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "CEO/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "912-355-7633"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; 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.