Individual
DAYRA VANESSA DIAZ-GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6100 VETERANS PKWY STE 11, COLUMBUS, GA 31909-3514
(706) 221-8966
Mailing address
6100 VETERANS PKWY STE 11, COLUMBUS, GA 31909-3514
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-37198
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071423
CPH
—
Enumeration date
01/15/2018
Last updated
02/08/2022
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