Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 16-24926 | SC |
NPI | 1003393943 |
---|---|
Provider Name | Rodriqua Mcquire |
First Address | Nashville, TN 37217-2646 |
Second Address | Ladys Island, SC 29907-1575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2018 |
Last Update Date | 24/07/2018 |