Individual
GRACE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
925 CONFERENCE DR, GREENVILLE, NC 27858-5971
(252) 689-6645
Mailing address
104 WYNDHAM CIR APT K, GREENVILLE, NC 27858-1658
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/26/2020
Last updated
02/26/2020
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