Derrisha Charnee Wilson Graham
Behavior Technician in Ontario, CA. Individual provider (NPI-1).
NPI number1649924366
StatusActive
Last updated in NPPESFeb 10, 2022
Details
- NPI
- 1649924366
- Entity type
- Individual (NPI-1)
- Name
- Derrisha Charnee Wilson Graham
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 10, 2022
- Certification date
- Feb 10, 2022
- Last updated
- Feb 10, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
4688 Ontario Mills PkwyOntario, CA 91764-5104
Phone 909-476-5747
Mailing address
4688 Ontario Mills PkwyOntario, CA 91764-5104
Phone 909-476-5747
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