Provider Demographics
NPI:1952067845
Name:CLUCKEY, KAYLYN NICOLE (RBT)
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:NICOLE
Last Name:CLUCKEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10468 INVESTORS PL STE B
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1749
Mailing Address - Country:US
Mailing Address - Phone:757-384-3248
Mailing Address - Fax:540-301-8315
Practice Address - Street 1:10468 INVESTORS PL STE B
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1749
Practice Address - Country:US
Practice Address - Phone:757-384-3248
Practice Address - Fax:540-301-8315
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-192945106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician