Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003386095 |
---|---|
Provider Name | Chantana B Collins |
First Address | Columbia, MD 21046-1457 |
Second Address | Columbia, MD 21046-1457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2018 |
Last Update Date | 03/12/2018 |