Individual
MRS. SOMMER MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., BCBA, LBA
Contact information
Practice address
315 MAIN ST, STEVENSVILLE, MD 21666-2082
(443) 226-8381
Mailing address
315 MAIN ST, STEVENSVILLE, MD 21666-2082
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA1504
MD
106S00000X
Behavior Technician
RBT-17-45297
MD
Other
Enumeration date
05/25/2018
Last updated
04/04/2023
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