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General NPI Number Information
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NPI Number | 1821852070
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Entity Type | Individual
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Provider Name | BRENDA NICHOL WEBB BCB
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Gender | Female
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 100 COMMERCE CT
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City | POOLER
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State | GA
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Zip | 31322-9445
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Country | US
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Telephone | 615-560-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 109 SADDLEBRUSH RD
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City | ELLABELL
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State | GA
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Zip | 31308-7404
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Country | US
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Telephone | 423-863-1412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-59948
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License Number State |
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