Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1154809747 |
---|---|
Provider Name | Tyrone J Dudley |
First Address | Roanoke, VA 24015-2528 |
Second Address | Lynchburg, VA 24502-2828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2018 |
Last Update Date | 06/08/2018 |