Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-14-6077 |
NPI | 1053850891 |
---|---|
Provider Name | Jessica Gildea |
First Address | Charlotte, NC 28227-7824 |
Second Address | Charlotte, NC 28227-7824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2017 |
Last Update Date | 13/02/2017 |