Individual
STACIA LATORRIA EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
5175 ELMORE RD STE 1, MEMPHIS, TN 38134-5629
(901) 275-9491
Mailing address
5175 ELMORE RD STE 1, MEMPHIS, TN 38134-5629
(901) 275-9491
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-27070
TN
Other
Enumeration date
09/22/2017
Last updated
12/06/2020
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