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General NPI Number Information
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NPI Number | 1336677343
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Entity Type | Organization
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Legal Business Name | DESTINED 4 GREATER CONSULTING & COUNSELING LLC.
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Dates
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Enumeration Date | 06/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 108 PINNACLE CT
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City | SAVANNAH
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State | GA
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Zip | 31419-0013
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Country | US
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Telephone | 760-258-7397
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Fax |
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Provider Business Mailing Address
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Address Line | 108 PINNACLE CT
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City | SAVANNAH
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State | GA
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Zip | 31419-0013
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Country | US
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Telephone | 760-258-7397
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL ANALYST
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Name | DR. LANICKAYARA NATSON
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Credential | PH.D
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Telephone | 760-258-7397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | RBT-15-1316-08198
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License Number State | GA
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