Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 0133001058 | VA |
NPI | 1003301540 |
---|---|
Provider Name | Kathleen Clay |
First Address | Charlottesville, VA 22902-5374 |
Second Address | Charlottesville, VA 22911-7228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2018 |
Last Update Date | 27/06/2018 |