Provider Demographics
NPI:1801614433
Name:YOUNG, DIAMOND ROSE (RBT)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:ROSE
Last Name:YOUNG
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 1:9012 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2992
Mailing Address - Country:US
Mailing Address - Phone:513-908-4534
Mailing Address - Fax:
Practice Address - Street 1:9012 COUNTRYSIDE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-2992
Practice Address - Country:US
Practice Address - Phone:513-908-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-24-350809106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst