Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-19-34588 | IN |
NPI | 1003477472 |
---|---|
Provider Name | Mrs. Kara Joan Kitchel-Overton |
First Address | Stokesdale, NC 27357-9408 |
Second Address | Stokesdale, NC 27357-9408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 25/06/2019 |