Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 12150335 | GA |
N | 106S00000X | Behavior Technician |
NPI | 1003302522 |
---|---|
Provider Name | Ashley Bragg |
First Address | San Francisco, CA 94139-9318 |
Second Address | Atlanta, GA 30350-6205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2018 |
Last Update Date | 06/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
928306085 | AETNA (01) | GA |