Individual
MRS. TIA MARIE FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
925 DUDLEY PIKE, EDGEWOOD, KY 41017-8120
(859) 360-3006
Mailing address
562 MICHELLE CT APT 22, ERLANGER, KY 41018-3204
(859) 322-5553
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/27/2021
Last updated
10/27/2021
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