Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BACB305765 |
NPI | 1003323916 |
---|---|
Provider Name | Courtney Wolfson |
First Address | Alexandria, VA 22310-2552 |
Second Address | Alexandria, VA 22310-2552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2018 |
Last Update Date | 02/01/2018 |