Provider Demographics
NPI:1598934762
Name:KLINE, DARA T (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:T
Last Name:KLINE
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 NIGGS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6417
Mailing Address - Country:US
Mailing Address - Phone:423-215-3044
Mailing Address - Fax:423-286-9095
Practice Address - Street 1:1637 NIGGS CREEK RD
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6417
Practice Address - Country:US
Practice Address - Phone:423-215-3044
Practice Address - Fax:423-286-9095
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01073575103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral