Individual
BRIELLE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 GRAND CENTRAL BLVD STE 101, POOLER, GA 31322-4146
(912) 388-1035
Mailing address
105 GRAND CENTRAL BLVD STE 101, POOLER, GA 31322-4146
(912) 388-1035
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-217339
GA
Other
Enumeration date
05/24/2022
Last updated
05/24/2022
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