Individual
ANNYIAH J BENJAMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4700 RUCKER BLVD, ENTERPRISE, AL 36330-8736
(334) 464-0063
Mailing address
2543 ROSS CLARK CIR, DOTHAN, AL 36301-4925
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1180687
AL
Other
Enumeration date
08/19/2024
Last updated
09/17/2024
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