MEDICARE: WHITNEY DURANT BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-75464

General Provider Information

NPI Number	:	1992204515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY DURANT BCBA

Provider Business Mailing Address
First Line	:	119 CANAL ST STE 103
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4094
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 PIPEMAKERS CIR STE 116
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4168
Country	:	US
Telephone Number	:	912-330-7171
Fax Number	:	888-413-4567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	09/05/2024

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