Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003498122 |
---|---|
Provider Name | Kerrie Marie Self |
First Address | Lawndale, NC 28090-8419 |
Second Address | Lincolnton, NC 28092-3449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2021 |
Last Update Date | 27/04/2021 |