Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003396797 |
---|---|
Provider Name | Amara-Niani Jackson |
First Address | Thurmont, MD 21788-2719 |
Second Address | Thurmont, MD 21788-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |