Organization
WILD CHILD THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAREL GORDON BCBA (DIRECTOR OF ABA SERVICES)
(540) 815-1693
Entity
Organization
Contact information
Practice address
1028 WINONA AVE SW, ROANOKE, VA 24015-5328
(540) 815-1693
Mailing address
1028 WINONA AVE SW, ROANOKE, VA 24015-5328
(540) 815-1693
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/27/2020
Last updated
02/27/2020
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