Individual
JALISSA WRIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1237 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(762) 685-4340
Mailing address
1237 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(762) 685-4340
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-114605
SC
Other
Enumeration date
06/17/2021
Last updated
06/17/2021
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