Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003341371 |
---|---|
Provider Name | A'lyecia Ruth Stills |
First Address | Shreveport, LA 71107-4829 |
Second Address | Shreveport, LA 71107-6537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2017 |
Last Update Date | 25/04/2017 |