Provider Demographics
NPI:1447074612
Name:NEVILLE, DIANE L CUMMINGS (RBT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L CUMMINGS
Last Name:NEVILLE
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 1:107 MILLER CT
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-6501
Mailing Address - Country:US
Mailing Address - Phone:786-752-5370
Mailing Address - Fax:
Practice Address - Street 1:206 WHITE OAKS BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32409-2370
Practice Address - Country:US
Practice Address - Phone:561-584-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLBACB1151842106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician