Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-10482 | FL |
NPI | 1124694294 |
---|---|
Provider Name | Nia Dillard |
First Address | Largo, FL 33770-2655 |
Second Address | Saint Petersburg, FL 33702-2189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2021 |
Last Update Date | 05/06/2021 |