Individual
TARA INGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5488 CHAMBLEE DUNWOODY RD STE 7, DUNWOODY, GA 30338-4161
(404) 480-3842
Mailing address
2580 LIN DO CT, SUMTER, SC 29150-1832
(803) 905-4427
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-35326
GA
Other
Enumeration date
07/03/2018
Last updated
04/15/2019
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