Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1003347501 |
---|---|
Provider Name | Kathryn Lynn Brock |
First Address | Newport News, VA 23601-1533 |
Second Address | Newport News, VA 23601-1533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2017 |
Last Update Date | 22/04/2021 |