Provider Demographics
NPI:1770456824
Name:GAVANDITTI, KARSON LEIGH (RBT)
Entity type:Individual
Prefix:
First Name:KARSON
Middle Name:LEIGH
Last Name:GAVANDITTI
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 1:2410 COUNTY ROAD 651
Mailing Address - Street 2:
Mailing Address - City:CHANCELLOR
Mailing Address - State:AL
Mailing Address - Zip Code:36316-7014
Mailing Address - Country:US
Mailing Address - Phone:334-446-4799
Mailing Address - Fax:
Practice Address - Street 1:1415 HONEYSUCKLE RD STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1922
Practice Address - Country:US
Practice Address - Phone:334-446-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBACB1379934106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty