Healthcare Provider Details

I. General information

NPI: 1124638150
Provider Name (Legal Business Name): DIANA REAGIN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA LOERA RBT

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 DEAN FOREST RD BLDG 100
SAVANNAH GA
31405-9342
US

IV. Provider business mailing address

1 DIAMOND CAUSEWAY SUITE 21 - 121
SAVANNAH GA
31406-9515
US

V. Phone/Fax

Practice location:
  • Phone: 912-434-4343
  • Fax: 912-452-9600
Mailing address:
  • Phone: 912-434-4343
  • Fax: 912-452-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-64436
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: