Healthcare Provider Details

I. General information

NPI: 1700709706
Provider Name (Legal Business Name): LAINDIA MINCEY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TOWN PARK BLVD STE 400
EVANS GA
30809-3515
US

IV. Provider business mailing address

6816 SOUTHPOINT PKWY STE 500
JACKSONVILLE FL
32216-1702
US

V. Phone/Fax

Practice location:
  • Phone: 904-538-0713
  • Fax: 904-538-0714
Mailing address:
  • Phone: 904-538-0713
  • Fax: 904-538-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-524633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: