Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003399114 |
---|---|
Provider Name | Lane Cassidy Tesseneer |
First Address | Grover, NC 28073-9784 |
Second Address | Charlotte, NC 28204-6300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2018 |
Last Update Date | 13/09/2018 |