Individual provider Active NPI

Destiny Faulcon

  • Behavior Technician
  • Virginia Beach, VA
National Provider Identifier
1962049882
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
780 Lynnhaven Pkwy Ste 400
Virginia Beach, VA 23452-7332
Phone
(757) 849-8138
NPI assigned
Dec 10, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X B61701408 VA
Behavior Technician 106S00000X VA Primary
Behavior Analyst 103K00000X

Addresses

Primary practice location

780 Lynnhaven Pkwy Ste 400
Virginia Beach, VA 23452-7332

Mailing address

350 Fairway Dr Ste 101
Deerfield Beach, FL 33441-1834
Phone (877) 418-2978

Other practice location 1

21600 Oxnard St Ste 1800
Woodland Hills, CA 91367-7807
Phone (818) 345-2345

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
B61701408VAMDBehavioral Analyst

NPI Registry JSON

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1962049882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 FAIRWAY DR STE 101",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334411834",
            "telephone_number": "877-418-2978",
            "fax_number": "866-500-2186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 LYNNHAVEN PKWY STE 400",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527332",
            "telephone_number": "757-849-8138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21600 Oxnard St Ste 1800",
            "address_purpose": "LOCATION",
            "city": "Woodland Hills",
            "state": "CA",
            "postal_code": "913677807",
            "country_code": "US",
            "telephone_number": "818-345-2345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAULCON",
        "first_name": "DESTINY",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-10",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "B61701408",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "VA",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.