Individual
VIDESHA MARYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11316 MUSETTE CIR, ALPHARETTA, GA 30009-2127
(918) 852-4042
Mailing address
11316 MUSETTE CIR, ALPHARETTA, GA 30009-2127
(918) 852-4042
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-16344
GA
Other
Enumeration date
09/09/2014
Last updated
01/07/2020
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