Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003419672 |
---|---|
Provider Name | Jennifer Correll |
First Address | Chesapeake, VA 23322-4389 |
Second Address | Moyock, NC 27958-9284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2020 |
Last Update Date | 17/11/2020 |