Individual
COLLEEN WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED. BCBA LBA
Contact information
Practice address
11614 SEVEN LOCKS RD, ROCKVILLE, MD 20854-3261
(301) 469-0223
Mailing address
360 WIREGRASS LN, SOUTHERN PINES, NC 28387-3062
(925) 785-8986
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
250
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-16-22211
BCBA
MD
Enumeration date
02/02/2021
Last updated
02/02/2021
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