Provider Demographics
NPI:1043029481
Name:KING, NAKEISHA R (RBT)
Entity type:Individual
Prefix:
First Name:NAKEISHA
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 MATILDA LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-4443
Mailing Address - Country:US
Mailing Address - Phone:706-393-6568
Mailing Address - Fax:
Practice Address - Street 1:3507 MATILDA LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-4443
Practice Address - Country:US
Practice Address - Phone:706-393-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB987792106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician