Individual
MISS SHANNON GRACE ERVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12731 MARBLESTONE DR, WOODBRIDGE, VA 22192-8333
(571) 589-0201
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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