Provider Demographics
NPI:1588305916
Name:FEAGIN, LAVESTA MONIQUE (BCBA)
Entity type:Individual
Prefix:
First Name:LAVESTA
Middle Name:MONIQUE
Last Name:FEAGIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 BULOXI BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6071
Mailing Address - Country:US
Mailing Address - Phone:678-201-4845
Mailing Address - Fax:
Practice Address - Street 1:1640 PHOENIX BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5572
Practice Address - Country:US
Practice Address - Phone:402-595-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-24-76240103K00000X
GARBT-22-210796106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician