Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-20-11173 |
NPI | 1063030567 |
---|---|
Provider Name | Zacaria Terry |
First Address | Simpsonville, SC 29681-6010 |
Second Address | Greenville, SC 29615-5044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2020 |
Last Update Date | 10/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0-20-11173 | BCABA (01) |