Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | BH001291 | PA |
NPI | 1043822125 |
---|---|
Provider Name | Mrs. Dayona Ellis |
First Address | Columbia, PA 17512-1121 |
Second Address | Columbia, PA 17512-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2020 |
Last Update Date | 19/08/2020 |