Individual
ELISE MARIE GRYBOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
702 DOUGLAS AVE, PORTSMOUTH, VA 23707-1908
(570) 809-4397
Mailing address
702 DOUGLAS AVE, PORTSMOUTH, VA 23707-1908
(570) 809-4397
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133001127
VA
Other
Enumeration date
06/10/2018
Last updated
06/10/2018
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