Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | FL |
NPI | 1053620559 |
---|---|
Provider Name | Ms. Sharon Helena Willis |
First Address | Melbourne, FL 32904-1093 |
Second Address | Cocoa, FL 32927-5216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 04/11/2020 |