Healthcare Provider Details

I. General information

NPI: 1235464561
Provider Name (Legal Business Name): REDA COSTON LMP, D.SC, PSYD/PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 WINDY HILL RD SE SUITE 206
MARIETTA GA
30067-8644
US

IV. Provider business mailing address

2480 WINDY HILL RD SE SUITE 206
MARIETTA GA
30067-8644
US

V. Phone/Fax

Practice location:
  • Phone: 855-525-1011
  • Fax: 770-953-0074
Mailing address:
  • Phone: 855-525-1011
  • Fax: 770-953-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberGADLRV41529
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberGA30080992
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberNALMCC2014239P
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0028882028
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number300800992
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number43963310
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberRYU-2012-11-35324
License Number StateZZ
# 8
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License NumberGMBH14112013
License Number StateZZ
# 9
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License NumberS5D4Q2Q4
License Number StateKS
# 10
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberG3D8D6T5
License Number StateGA
# 11
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberPS-000294
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: