Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 0133000323 | VA |
NPI | 1003247164 |
---|---|
Provider Name | Stacy Ulrich |
First Address | Vienna, VA 22182-5242 |
Second Address | Mc Lean, VA 22102-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2013 |
Last Update Date | 27/11/2013 |