Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003227786 |
---|---|
Provider Name | Mrs. Dovey Mia'tee Roberson |
First Address | Columbus, GA 31907-4519 |
Second Address | Columbus, GA 31901-5241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 22/09/2021 |