Individual
KIMBERLY LASHAUN ANTHONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
1517 LILY POND RD, ALBANY, GA 31701-7771
(229) 669-3311
Mailing address
1517 LILY POND RD, ALBANY, GA 31701-7771
(229) 669-3311
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-19-74736
GA
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071719050
DRIVERS LICENSE
GA
01
—
RBT-19-74736
RBT REGISTRATION NUMBER
GA
Enumeration date
03/20/2019
Last updated
02/04/2020
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