Healthcare Provider Details

I. General information

NPI: 1285583914
Provider Name (Legal Business Name): DORTHEIYA DARNEILA EVANS COOK RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 GA-138 SPUR SUITES 11 & 12,
JONESBORO GA
30238
US

IV. Provider business mailing address

659 REDLAND DR
JONESBORO GA
30238-4381
US

V. Phone/Fax

Practice location:
  • Phone: 470-883-2810
  • Fax:
Mailing address:
  • Phone: 678-698-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB952571
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: