Provider Demographics
NPI:1871268151
Name:WEST, DESTINY (RBT)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:WEST
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 1:137 JOHNSON FERRY RD STE 2170
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4948
Mailing Address - Country:US
Mailing Address - Phone:470-648-0513
Mailing Address - Fax:
Practice Address - Street 1:137 JOHNSON FERRY RD STE 2170
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4948
Practice Address - Country:US
Practice Address - Phone:470-648-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-179538106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician