Most Relevant Information
Provider Data
| NPI Number: | 1003306465 |
| Provider Name: | ADRIENNE NICOLE BLACK RBT-17-45544 |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-17-45544 |
Most Important Dates
| Enumeration Date: | 05/11/2018 |
| Last Updated: | 06/20/2024 |
Provider Practice Location
2808 FOX MEADOW LANE
JONESBORO
AR
72404
Practice Location Phone/Fax
| Phone: | 8709324245 |
| Fax: | 8709314457 |
Provider Mailing Location
2808 FOX MEADOW LANE
JONESBORO
AR
72404
Provider Mailing Phone/Fax
| Phone: | 8709324245 |
| Fax: | 8709314457 |