Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | RBT-21-164969 | GA |
NPI | 1073196747 |
---|---|
Provider Name | Amanda Hope Duke |
First Address | Valdosta, GA 31602-1099 |
Second Address | Valdosta, GA 31602-5944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2021 |
Last Update Date | 30/04/2021 |