Healthcare Provider Details

I. General information

NPI: 1427844620
Provider Name (Legal Business Name): ERIKA DANIELLE CIMINNISI RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N JEFF DAVIS DR
FAYETTEVILLE GA
30214-1627
US

IV. Provider business mailing address

90 KELLY LN
NEWNAN GA
30265-1403
US

V. Phone/Fax

Practice location:
  • Phone: 877-498-0319
  • Fax:
Mailing address:
  • Phone: 770-328-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-416607
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: