Individual
IRENE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2225 BEMISS RD STE D, VALDOSTA, GA 31602-4819
(800) 832-9419
Mailing address
2225 BEMISS RD STE D, VALDOSTA, GA 31602-4819
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
18-58930
GA
Other
Enumeration date
06/26/2018
Last updated
06/26/2018
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