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1225760507
JAEANNA LEE DIVINE BURRELL
DULUTH, GA
NPI
1225760507
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-06-27
Last Update Date
2022-06-27
Business Address
JAEANNA LEE DIVINE BURRELL
2810 PREMIERE PKWY STE 500
DULUTH, GA 30097-8912
Phone number: 470-207-0390
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Mailing Address
JAEANNA LEE DIVINE BURRELL
DEPT LA 22763
PASADENA, CA 91185-0001
Phone number: 678-396-5982
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