Individual
JAILENE GABRIELLA CUQUEJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4538 MILL GROVE TER, DOUGLASVILLE, GA 30135-4196
(404) 860-3621
Mailing address
4538 MILL GROVE TER, DOUGLASVILLE, GA 30135-4196
(404) 860-3621
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/21/2022
Last updated
12/21/2022
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