Individual
BIANCA D OUTLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1409 KEMPSVILLE RD, CHESAPEAKE, VA 23320-8134
(757) 416-5290
Mailing address
1409 KEMPSVILLE RD, CHESAPEAKE, VA 23320-8134
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-219408
VA
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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