Individual
TAMMY DIANNE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
810 SHONEY DR SW, HUNTSVILLE, AL 35801-5436
(850) 866-0441
Mailing address
810 SHONEY DR SW, HUNTSVILLE, AL 35801-5436
(256) 558-2010
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-214750
AL
Other
Enumeration date
06/29/2022
Last updated
06/29/2022
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