Provider Demographics
NPI:1013590496
Name:RICHARDSON, DIAMANTAE (RBT)
Entity Type:Individual
Prefix:
First Name:DIAMANTAE
Middle Name:
Last Name:RICHARDSON
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 1:3017 MEDLIN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2336
Mailing Address - Country:US
Mailing Address - Phone:817-752-4945
Mailing Address - Fax:
Practice Address - Street 1:3017 MEDLIN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2336
Practice Address - Country:US
Practice Address - Phone:817-752-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19-99240106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician