Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician |
NPI | 1003382979 |
---|---|
Provider Name | Ms. Saran Charisse Watts |
First Address | Wixom, MI 48393-2628 |
Second Address | Southgate, MI 48195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2018 |
Last Update Date | 18/09/2019 |