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Individual

MRS. JESSICA FUSCO BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCBA

Contact information

Practice address
1360 MACKEY BRANCH DR, CHATTANOOGA, TN 37421-3225
(423) 847-5749
Mailing address
1360 MACKEY BRANCH DR, CHATTANOOGA, TN 37421-3225

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-48414
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
471201135
TN
Enumeration date
03/15/2021
Last updated
03/06/2023
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