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Individual

ALEXIS OLIVIA FAGAN-DANIEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
225 CEDAR HILL ST STE 200, MARLBOROUGH, MA 01752-5900
(917) 270-2547
Mailing address
2180 DOVER CASTLE WAY, DECATUR, GA 30035-2124
(917) 270-2547

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
GA

Other

Enumeration date
12/05/2022
Last updated
12/05/2022
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