Individual
MACKENZIE BLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1021 HARGETT ST, JACKSONVILLE, NC 28540-5924
(704) 572-3810
Mailing address
1021 HARGETT ST, JACKSONVILLE, NC 28540-5924
(704) 572-3810
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
10/26/2021
Last updated
11/21/2023
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