Individual
BRANDI DAWN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 TIBET AVE APT 116A, SAVANNAH, GA 31406-5550
(912) 507-1159
Mailing address
316 MID VALLEY CTR # 186, CARMEL, CA 93923-8516
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/01/2019
Last updated
12/01/2019
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