Individual
AMANDA R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCAT
Contact information
Practice address
280 PINEHURST AVE STE 7, SOUTHERN PINES, NC 28387-7089
(800) 991-6070
Mailing address
316 MID VALLEY CTR # 186, CARMEL, CA 93923-8516
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
00012644
NC
Other
Enumeration date
12/01/2020
Last updated
12/01/2020
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