Individual
JESSICA GRANADOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
538 APRICOT ST, STAFFORD, VA 22554-2555
(540) 623-4127
Mailing address
538 APRICOT ST, STAFFORD, VA 22554-2555
(540) 623-4127
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-108250
VA
Other
Enumeration date
12/11/2019
Last updated
12/11/2019
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