Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1053961508 |
---|---|
Provider Name | Ambria Unsha Gordon |
First Address | Washington, DC 20020-4249 |
Second Address | Lanham, MD 20706-1868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2019 |
Last Update Date | 17/09/2019 |