Individual
COURTNEY NICHOLE LARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1155 CONCORD RD SE STE 220, SMYRNA, GA 30080-4234
(888) 509-6368
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-42409
GA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/20/2019
Last updated
06/22/2020
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