Individual
DENASIA ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 E 7TH ST, CHARLOTTE, NC 28204-6300
(252) 548-4587
Mailing address
14416 GLENDON HALL LN, CHARLOTTE, NC 28262-1642
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/03/2020
Last updated
07/03/2020
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