Individual
DAJA ANDREA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
408 1ST ST, LOUISVILLE, GA 30434-6503
(478) 206-6180
Mailing address
408 1ST ST, LOUISVILLE, GA 30434-6503
(478) 206-6180
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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