Provider Demographics
NPI:1578456513
Name:GRAVETTE, RENIKA ANDREA (RBT)
Entity type:Individual
Prefix:
First Name:RENIKA
Middle Name:ANDREA
Last Name:GRAVETTE
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 1:19605 PECAN AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4623
Mailing Address - Country:US
Mailing Address - Phone:323-320-0311
Mailing Address - Fax:
Practice Address - Street 1:300 HARVEST BOUNTY DR APT 303
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3191
Practice Address - Country:US
Practice Address - Phone:323-320-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-25-434899106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician