Most Relevant Information
Provider Data
| NPI Number: | 1003419672 |
| Provider Name: | JENNIFER CORRELL |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/17/2020 |
| Last Updated: | 11/17/2020 |
Provider Practice Location
108 ROCKY TOP RD
MOYOCK
NC
279589284
Practice Location Phone/Fax
| Phone: | 7577699595 |
| Fax: |
Provider Mailing Location
1912 STARLING ST APT 209
CHESAPEAKE
VA
233224389
Provider Mailing Phone/Fax
| Phone: | 7572698162 |
| Fax: |