Individual
MISS AD-ASTRA CUSTIS DANDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 TRIUMPHANT ST, HENDERSON, NV 89052-3918
(702) 503-0848
Mailing address
1020 TRIUMPHANT ST, HENDERSON, NV 89052-3918
(702) 503-0848
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/15/2023
Last updated
12/15/2023
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