Healthcare Provider Details

I. General information

NPI: 1669219374
Provider Name (Legal Business Name): DIAMOND CHILD BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 KETTERING CT
LONGWOOD FL
32779-4519
US

IV. Provider business mailing address

220 KETTERING CT
LONGWOOD FL
32779-4519
US

V. Phone/Fax

Practice location:
  • Phone: 407-866-5152
  • Fax: 407-866-5152
Mailing address:
  • Phone: 407-866-5152
  • Fax: 407-866-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA BRADLEY
Title or Position: OWNER
Credential: RBT
Phone: 407-866-5152