Individual
INDIA LEAKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8053 MALONE ST, DOUGLASVILLE, GA 30134-1238
(470) 599-0838
Mailing address
8053 MALONE ST, DOUGLASVILLE, GA 30134-1238
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/17/2023
Last updated
03/17/2023
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