Provider Demographics
NPI:1588239206
Name:MARBLEY, DESTINEE (RBT)
Entity Type:Individual
Prefix:MS
First Name:DESTINEE
Middle Name:
Last Name:MARBLEY
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 1:1800 JONESBORO RD SE
Mailing Address - Street 2:SUITE G9
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 JONESBORO RD SE
Practice Address - Street 2:G9
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315
Practice Address - Country:US
Practice Address - Phone:404-536-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GAMT014264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician