Individual
EBONY LAMYIAH WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 STAMBUK LN APT 1015, STATESBORO, GA 30458-0219
(706) 831-2501
Mailing address
2000 STAMBUK LN APT 1015, STATESBORO, GA 30458-0219
(706) 831-2501
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
GA
Other
Enumeration date
07/23/2021
Last updated
07/23/2021
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