Provider Demographics
NPI:1598206153
Name:FAISON, KAHDIJA BIANKA (RBT)
Entity Type:Individual
Prefix:
First Name:KAHDIJA
Middle Name:BIANKA
Last Name:FAISON
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 1:1330 WINTER GARDEN VINELAND RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4341
Mailing Address - Country:US
Mailing Address - Phone:407-395-9976
Mailing Address - Fax:
Practice Address - Street 1:1330 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4341
Practice Address - Country:US
Practice Address - Phone:407-395-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF250502946840106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician