Provider Demographics
NPI:1669194593
Name:FESTA, SANNA C R
Entity type:Individual
Prefix:
First Name:SANNA
Middle Name:C R
Last Name:FESTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANNA
Other - Middle Name:C
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 PARK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3598
Mailing Address - Country:US
Mailing Address - Phone:704-780-4271
Mailing Address - Fax:888-261-6694
Practice Address - Street 1:770 PARK CENTRE DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3598
Practice Address - Country:US
Practice Address - Phone:704-780-4271
Practice Address - Fax:888-261-6694
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician