Individual
BIBI QUINTANILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1471 LONG ACRE DR, LOGANVILLE, GA 30052-3149
(678) 392-7061
Mailing address
1471 LONG ACRE DR, LOGANVILLE, GA 30052-3149
(678) 392-7061
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/21/2022
Last updated
12/21/2022
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