Individual
MODESTA ALLENA FOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
412 FERRY CT, WAKE FOREST, NC 27587-4020
(919) 306-7477
Mailing address
412 FERRY CT, WAKE FOREST, NC 27587
(919) 306-7477
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
21384238
NC
Other
Enumeration date
05/17/2025
Last updated
05/17/2025
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