Individual
DECEMBER FALLON SARGENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
65 WALLACE RD, TRION, GA 30753-5500
(423) 693-5017
Mailing address
65 WALLACE RD, TRION, GA 30753-5500
(423) 693-5017
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-5131-507032
GA
Other
Enumeration date
03/21/2024
Last updated
03/21/2024
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