Provider Demographics
NPI:1689408114
Name:COUSIN, AYANA D
Entity type:Individual
Prefix:
First Name:AYANA
Middle Name:D
Last Name:COUSIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 BLUFFHOLLOW GAP
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4291
Mailing Address - Country:US
Mailing Address - Phone:931-503-4430
Mailing Address - Fax:
Practice Address - Street 1:3037 BLUFFHOLLOW GAP
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4291
Practice Address - Country:US
Practice Address - Phone:931-503-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician