Organization
BUILDING BLOCK RESOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER C CHARLES BCBA (OWNER)
(424) 272-5238
Entity
Organization
Contact information
Practice address
13428 MAXELLA AVE # 913, MARINA DEL REY, CA 90292-5620
(424) 272-5238
Mailing address
13428 MAXELLA AVE # 913, MARINA DEL REY, CA 90292-5620
(424) 272-5238
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002686900
—
FL
Enumeration date
01/23/2015
Last updated
01/23/2015
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