Provider Demographics
NPI:1982328365
Name:GATLING, BRITTNEY LATAVIA
Entity Type:Individual
Prefix:MISS
First Name:BRITTNEY
Middle Name:LATAVIA
Last Name:GATLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 SUNGROVE LN APT 217
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-9503
Mailing Address - Country:US
Mailing Address - Phone:984-298-9877
Mailing Address - Fax:
Practice Address - Street 1:3311 SUNGROVE LN APT 217
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-9503
Practice Address - Country:US
Practice Address - Phone:984-298-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC945067273NMedicaid