Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003400623 |
---|---|
Provider Name | Missy Rose White |
First Address | Lake Mary, FL 32746-3625 |
Second Address | Gainesville, GA 30501-3445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2021 |
Last Update Date | 24/02/2021 |