Healthcare Provider Details

I. General information

NPI: 1285559203
Provider Name (Legal Business Name): MS. KWANTIA R MCCLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3966 ATLANTA HWY STE 375
MONTGOMERY AL
36109-2919
US

IV. Provider business mailing address

209 RIVER RD
WETUMPKA AL
36092-1413
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 334-207-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number7534441
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number7534441
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7534441
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: