Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | RBT-19-7922-179166 | VA |
NPI | 1003453341 |
---|---|
Provider Name | Kayla Minton |
First Address | Virginia Beach, VA 23462-6529 |
Second Address | Virginia Beach, VA 23462-6529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2019 |
Last Update Date | 05/12/2019 |