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Individual

ALYSSA NICOLE BOURQUE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
612 S WATFORD RD, SLOCOMB, AL 36375-6952
(334) 258-5482
Mailing address
612 S WATFORD RD, SLOCOMB, AL 36375-6952
(334) 258-5482

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
54217716
AL
Enumeration date
07/26/2021
Last updated
07/26/2021
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