Provider Demographics
NPI:1235464561
Name:COSTON, REDA (LMP, DSC, PSYD/PHD)
Entity Type:Individual
Prefix:DR
First Name:REDA
Middle Name:
Last Name:COSTON
Suffix:
Gender:F
Credentials:LMP, DSC, PSYD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8644
Mailing Address - Country:US
Mailing Address - Phone:855-525-1011
Mailing Address - Fax:770-953-0074
Practice Address - Street 1:2480 WINDY HILL RD SE
Practice Address - Street 2:SUITE 206
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8644
Practice Address - Country:US
Practice Address - Phone:855-525-1011
Practice Address - Fax:770-953-0074
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZGMBH141120132083T0002X
CAGA30080992133N00000X
COPS-000294173C00000X
TX43963310175F00000X
NYGADLRV41529103TB0200X
KSS5D4Q2Q4246RM2200X
CA300800992133NN1002X
GAG3D8D6T5246RP1900X
GACN0028882028376K00000X
NVNALMCC2014239P376G00000X
ZZRYU-2012-11-353242083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No173C00000XOther Service ProvidersReflexologist
No175F00000XOther Service ProvidersNaturopath
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No376K00000XNursing Service Related ProvidersNurse's Aide
No376G00000XNursing Service Related ProvidersNursing Home Administrator