Individual
ASHLEY JULISSA LOPEZ SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
185 MITTIE HADDOCK DR, CAMERON, NC 28326-9379
(910) 500-7783
Mailing address
185 MITTIE HADDOCK DR, CAMERON, NC 28326-9379
(910) 500-7783
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB998353
NC
Other
Enumeration date
08/25/2023
Last updated
08/25/2023
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