NPIMap

Individual provider Active NPI

Victoria Ladrondeguevara

  • Behavior Analyst
  • Douglasville, GA
National Provider Identifier
1962052100
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-21-51361 Issued in TX
Practice address
9559 Highway 5 Ste 601
Douglasville, GA 30135-1572
Phone
(470) 632-5276
NPI assigned
Sep 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-19-87592
Behavior Analyst 103K00000X 1-21-51361 TX Primary

Addresses

Primary practice location

9559 Highway 5 Ste 601
Douglasville, GA 30135-1572

Mailing address

6140 Avery Dr Apt 6302
Fort Worth, TX 76132-5314
Phone (903) 421-5960

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Cone Therapies LLC Behavior Analyst PastSince Sep 1, 2019 Accepting new patients
Radiance Behavior Therapy, LLC Behavior Analyst Past Accepting new patients
Achievements ABA Therapy Ga LLC Behavior Analyst Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1962052100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 AVERY DR APT 6302",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761325314",
            "telephone_number": "903-421-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9559 HIGHWAY 5 STE 601",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351572",
            "telephone_number": "470-632-5276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LADRONDEGUEVARA",
        "first_name": "VICTORIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-19",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": "RBT-19-87592",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "TX",
            "license": "1-21-51361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; 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.