Provider Demographics
NPI:1124638150
Name:REAGIN, DIANA (BCBA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:REAGIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:LOERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1 DIAMOND CAUSEWAY
Mailing Address - Street 2:SUITE 21 - 121
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-9515
Mailing Address - Country:US
Mailing Address - Phone:912-434-4343
Mailing Address - Fax:912-452-9600
Practice Address - Street 1:1481 DEAN FOREST RD BLDG 100
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-9342
Practice Address - Country:US
Practice Address - Phone:912-434-4343
Practice Address - Fax:912-452-9600
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18-64436106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-23-65473OtherBACB CREDENTIALING BOARD
18-64436OtherRBT CERTIFICATION - RELIAS LEARNING