Individual
JULISSA IVELISE LOPEZ CORREA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
185 MITTIE HADDOCK DR, CAMERON, NC 28326-9379
(386) 717-9131
Mailing address
316 MID VALLEY CTR # 186, CARMEL, CA 93923-8516
(800) 991-6070
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
Primary
8744
—
Other
Enumeration date
11/25/2017
Last updated
04/28/2021
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