Individual
JESSICA VASHAUN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4189 WHITE RD, SNELLVILLE, GA 30039-4242
(470) 485-2220
Mailing address
4189 WHITE RD, SNELLVILLE, GA 30039-4242
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0167450
GA
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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