Individual
ABYGAIL MENTORIA FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5252 ORANGE AVE, CYPRESS, CA 90630-2967
(657) 213-0199
Mailing address
996 ROYAL MARCO WAY, MARCO ISLAND, FL 34145-1829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/13/2025
Last updated
02/13/2025
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