Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-56130 | GA |
N | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1053978940 |
---|---|
Provider Name | Anna Marie Ballinger |
First Address | Lake Mary, FL 32746-5028 |
Second Address | Woodstock, GA 30188-4461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2019 |
Last Update Date | 08/12/2021 |