Individual
EBONIE R ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 13TH ST STE D, COLUMBUS, GA 31901-2246
(706) 780-1704
Mailing address
1110 13TH ST STE D, COLUMBUS, GA 31901-2246
(706) 780-1704
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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