Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-67284 | |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1306235528 |
---|---|
Provider Name | Ashley Daly |
First Address | Nashville, TN 37217-2679 |
Second Address | Columbia, SC 29229-8420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2015 |
Last Update Date | 25/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
82 | (05) | NV |
82 | AMERIGROUP (01) | NV |