Provider Demographics
NPI:1639838592
Name:COSTA, LAYARA CRYSTINE (RBT)
Entity Type:Individual
Prefix:
First Name:LAYARA
Middle Name:CRYSTINE
Last Name:COSTA
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 1:258 ASPEN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1462
Mailing Address - Country:US
Mailing Address - Phone:678-799-4814
Mailing Address - Fax:
Practice Address - Street 1:258 ASPEN VALLEY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1462
Practice Address - Country:US
Practice Address - Phone:678-799-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst