Individual
EBONY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12308 COUGAR LN SE, ALBUQUERQUE, NM 87123-3527
(505) 365-9012
Mailing address
12308 COUGAR LN SE, ALBUQUERQUE, NM 87123-3527
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/11/2023
Last updated
04/11/2023
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