Individual
DAPHNE GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
1138 2ND ST SW, ROANOKE, VA 24016-4725
(980) 785-1113
(980) 785-1114
Mailing address
6850 LEE HWY, TROUTVILLE, VA 24175-5919
(540) 580-8790
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0134000251
VA
106S00000X
Behavior Technician
RBT-17-33544
VA
Other
Enumeration date
12/12/2017
Last updated
02/23/2022
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