Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | LA |
NPI | 1003371451 |
---|---|
Provider Name | Gracie Dugas |
First Address | Deerfield Beach, FL 33441-1817 |
Second Address | Metairie, LA 70006-6713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2019 |
Last Update Date | 08/02/2019 |