Individual
SELENA TIMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
102 YORKSHIRE DR, GREENVILLE, SC 29615-1129
(864) 631-6803
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
102203918
SC
Other
Enumeration date
08/29/2023
Last updated
08/29/2023
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