Individual
JORDAN ELISABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1114 MAIN ST APT A, DANVILLE, VA 24541-2954
(434) 709-7107
Mailing address
1114 MAIN ST APT A, DANVILLE, VA 24541-2954
(434) 709-7107
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-15-05000
VA
Other
Enumeration date
09/18/2017
Last updated
07/21/2022
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