Provider Demographics
NPI:1871883678
Name:MORGAN, DARNETHIA (MED, LBA, BCBA)
Entity type:Individual
Prefix:
First Name:DARNETHIA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MED, LBA, BCBA
Other - Prefix:
Other - First Name:DARNETHIA
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1959 SARSEN CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2353
Mailing Address - Country:US
Mailing Address - Phone:901-288-6825
Mailing Address - Fax:
Practice Address - Street 1:1845 MORIAH WOODS BLVD STE 7
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7123
Practice Address - Country:US
Practice Address - Phone:901-288-6825
Practice Address - Fax:901-284-2094
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18106E00000X
TN90103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
14390451OtherCAQH