Individual
DIAMOND PILGRIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1985 E MAIN ST STE 12, SPARTANBURG, SC 29307-2314
(803) 905-5107
Mailing address
181 W PROFESSIONAL PARK CT STE 1, BOWLING GREEN, KY 42104-3250
(270) 777-9283
(270) 777-9283
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-41204
SC
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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