Individual
BLAIR WELLMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
ALOHA BEHAVIORAL PRACTICE, 25 KANEOHE BAY DRIVE, KAILUA, HI 96734
(808) 388-1683
Mailing address
2047 ANENA ST, KAILUA, HI 96734-6802
(845) 542-1827
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BACB403898
HI
106S00000X
Behavior Technician
RBT-18-53119
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BACB403898
BCBA
HI
01
—
RBT-18-53119
RBT
FL
Enumeration date
01/22/2019
Last updated
09/13/2021
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