Individual
CHRISTAL RENAE THREATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
916 COX RD, GASTONIA, NC 28054-3496
(704) 780-4271
Mailing address
1028 BOLIVIA DR, GASTONIA, NC 28054-4311
(704) 890-8074
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
000037090505
NC
Other
Enumeration date
12/17/2020
Last updated
12/17/2020
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