Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1134690290 |
---|---|
Provider Name | Shantavies Dior Morning |
First Address | Columbus, GA 31903-1220 |
Second Address | Columbus, GA 31906-3129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 11/02/2019 |