Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-16-7598 | WV |
NPI | 1164918371 |
---|---|
Provider Name | Alexis Spence |
First Address | Barboursville, WV 25504-4100 |
Second Address | Winfield, WV 25213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |