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Individual

DIANA DE LOE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2901 STILESBORO RIDGE WAY NW, KENNESAW, GA 30152-7449
(404) 680-7313
Mailing address
50 PLAZA WAY NW STE A, MARIETTA, GA 30060-1141
(678) 691-2206

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-173999
GA
106S00000X
Behavior Technician
RBT-21-173999

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RBT-21-173999
RBT
GA
Enumeration date
06/30/2021
Last updated
11/18/2021
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