Healthcare Provider Details

I. General information

NPI: 1144077124
Provider Name (Legal Business Name): DE'STYNI MCCLURE-REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 AUGUSTA WEST PKWY STE 1B
AUGUSTA GA
30909-1808
US

IV. Provider business mailing address

1212 AUGUSTA WEST PKWY STE 1B
AUGUSTA GA
30909-1808
US

V. Phone/Fax

Practice location:
  • Phone: 706-826-2770
  • Fax: 706-826-2771
Mailing address:
  • Phone: 706-826-2770
  • Fax: 706-826-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-345233
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: