Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-21-13024 | |
N | 106S00000X | Behavior Technician |
NPI | 1124637707 |
---|---|
Provider Name | Hallie Carroll |
First Address | Stuart, FL 34997-7462 |
Second Address | Stuart, FL 34997-7462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2020 |
Last Update Date | 21/12/2021 |