Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003404302 |
---|---|
Provider Name | Pamela Marie Perdue |
First Address | Hardy, VA 24101-5802 |
Second Address | Hardy, VA 24101-5802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2021 |
Last Update Date | 04/01/2021 |