Individual
ASHLEY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24 JOE KENNEDY BLVD STE 3, STATESBORO, GA 30458-3103
(912) 208-2024
Mailing address
PO BOX 663, LAKELAND, MI 48143-0663
(810) 599-2129
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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