Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BCBA-18-5547-100602 | GA |
NPI | 1003222696 |
---|---|
Provider Name | Carline Die |
First Address | Midland, GA 31820-6314 |
Second Address | Sandy Springs, GA 30328-5473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2014 |
Last Update Date | 13/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003222696 | (05) | GA |