Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | BCABA-17-9537-082580 | AL |
NPI | 1083120315 |
---|---|
Provider Name | Shelby Regena Dunagan |
First Address | Vestavia, AL 35243-1653 |
Second Address | Vestavia, AL 35243-1653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2017 |
Last Update Date | 22/12/2017 |