Provider Demographics
NPI:1861098790
Name:DARVILLE, ANTONZIA (BCABA)
Entity type:Individual
Prefix:
First Name:ANTONZIA
Middle Name:
Last Name:DARVILLE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 N POINT BLVD APT 1006
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4181
Mailing Address - Country:US
Mailing Address - Phone:850-901-2385
Mailing Address - Fax:
Practice Address - Street 1:1950 N POINT BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4168
Practice Address - Country:US
Practice Address - Phone:850-902-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-23-14668106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107729700Medicaid