Individual
BRIE BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
418B W MOUNTAIN ST, KERNERSVILLE, NC 27284-2534
(704) 780-4271
(888) 261-6694
Mailing address
218 REDWOOD DR, MOCKSVILLE, NC 27028-5435
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NC
Other
Enumeration date
11/21/2020
Last updated
11/21/2020
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