Individual
HEATHER DAWN VANGORKUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 13TH ST STE D, COLUMBUS, GA 31901-2246
(706) 780-1705
Mailing address
23 ISBELL RD, FORT MITCHELL, AL 36856-5587
(912) 996-7752
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-113779
GA
Other
Enumeration date
04/13/2020
Last updated
04/13/2020
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