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Individual

TARA SOUTHALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
BCABA

Contact information

Practice address
1314 RIVERLAND RD SE, ROANOKE, VA 24014-3610
(540) 566-3670
Mailing address
22 CROSS CREEK CIR, CLOVERDALE, VA 24077-3038
(540) 272-0462

Taxonomy

Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0134000265
VA

Other

Enumeration date
11/22/2016
Last updated
02/04/2020
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