Provider Demographics
NPI:1043563901
Name:FEASTER, KIONNE A (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KIONNE
Middle Name:A
Last Name:FEASTER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 BARNSLEY DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8243
Mailing Address - Country:US
Mailing Address - Phone:404-514-1183
Mailing Address - Fax:
Practice Address - Street 1:7779 HYTHE CIR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-8704
Practice Address - Country:US
Practice Address - Phone:404-514-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01-08-4330103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst