Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | PA |
NPI | 1003374489 |
---|---|
Provider Name | Janiesha Tate |
First Address | Rockville, MD 20855-2733 |
Second Address | Rockville, MD 20855-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2019 |
Last Update Date | 05/03/2019 |