Individual
DANIELLE LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
126 PAVILION PKWY, FAYETTEVILLE, GA 30214-4056
(770) 954-8988
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-138010
GA
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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