Individual
DERRICA SHAVONTA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7730 LYNCH RD, MIDLAND, GA 31820
(912) 385-4648
Mailing address
7330 LYNCH RD, MIDLAND, GA 31820-4010
(912) 385-4648
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-268815
GA
Other
Enumeration date
08/02/2023
Last updated
08/09/2023
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