Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-68522 | GA |
NPI | 1003384173 |
---|---|
Provider Name | Mrs. India Campbell |
First Address | Columbus, GA 31901-2246 |
Second Address | Columbus, GA 31901-2246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2018 |
Last Update Date | 10/08/2020 |