Provider Demographics
NPI:1114510898
Name:RANDALL, AL'NEISHA JABRIA (RBT)
Entity Type:Individual
Prefix:
First Name:AL'NEISHA
Middle Name:JABRIA
Last Name:RANDALL
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 1:1 DIAMOND CAUSEWAY
Mailing Address - Street 2:SUITE 21 - 121
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-434-4343
Mailing Address - Fax:912-452-9600
Practice Address - Street 1:5710 OGEECHEE ROAD
Practice Address - Street 2:SUITE 200 - 251
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3140
Practice Address - Country:US
Practice Address - Phone:912-434-4343
Practice Address - Fax:912-452-9600
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-154827106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
21-154827OtherRBT CERTIFICATION - PEARSON