Provider Demographics
NPI:1851924799
Name:HEAVEN, DARLENE DELILAH (MS, BCBA)
Entity type:Individual
Prefix:
First Name:DARLENE DELILAH
Middle Name:
Last Name:HEAVEN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:DELILAH
Other - Middle Name:
Other - Last Name:HEAVEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:2888 ROLLING DOWNS WAY
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7922
Mailing Address - Country:US
Mailing Address - Phone:336-250-3891
Mailing Address - Fax:
Practice Address - Street 1:621 MACON ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3531
Practice Address - Country:US
Practice Address - Phone:404-422-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-21-53959103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst