Provider Demographics
NPI:1316831084
Name:GAMBLIN, DESTINY ASTARIA (RBT)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:ASTARIA
Last Name:GAMBLIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17213 DELANEY DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8295
Mailing Address - Country:US
Mailing Address - Phone:704-853-4186
Mailing Address - Fax:
Practice Address - Street 1:9920 KINCEY AVE STE 150
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2457
Practice Address - Country:US
Practice Address - Phone:704-853-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-25-436720106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician