| NPI | 1265104418 |
|---|---|
| Former Name | DERRICKA F FORTSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-22-62360) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2022-11-14 |