Organization
CHILD'S PLAY BEHAVIOR ANALYSIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA MARIE-ROSE FULCHER MA, BCBA (BEHAVIOR ANALYST)
(423) 582-9494
Entity
Organization
Contact information
Practice address
670 CHADINGS DR, ROANOKE, IN 46783-8875
(423) 582-9494
Mailing address
670 CHADINGS DR, ROANOKE, IN 46783-8875
(423) 582-9494
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1107501
IL
Other
Enumeration date
07/07/2011
Last updated
01/21/2013
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