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1790418002
FAYETTE JACKSON-LONG
BOSTON, MA
NPI
1790418002
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-07-05
Last Update Date
2022-07-05
Business Address
FAYETTE JACKSON-LONG
418 CENTRE ST UNIT C
BOSTON, MA 02130-5197
Phone number: 800-249-1266
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Mailing Address
FAYETTE JACKSON-LONG
1301 E ORANGEWOOD AVE
ANAHEIM, CA 92805-6807
Phone number:
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