Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | RBT-20-131901 | GA |
NPI | 1003442484 |
---|---|
Provider Name | Angelique Jones |
First Address | Columbus, GA 31904-4494 |
Second Address | Columbus, GA 31904-4494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2020 |
Last Update Date | 20/08/2020 |