Individual
MAMIE HEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1894 LUDOVIE LN, DECATUR, GA 30033-1044
(678) 626-0557
Mailing address
1894 LUDOVIE LN, DECATUR, GA 30033-1044
(678) 626-0557
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-46113
GA
Other
Enumeration date
12/01/2020
Last updated
12/01/2020
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