Individual provider · NPI-1

Dominique Anderson

Behavior Analyst · Bowie, MD

NPI number1679172225
StatusActive
Last updated in NPPESOct 15, 2024

Details

NPI
1679172225
Entity type
Individual (NPI-1)
Name
Dominique Anderson
Sex
Female
Sole proprietor
No
Enumeration date
Oct 23, 2020
Certification date
Oct 15, 2024
Last updated
Oct 15, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103K00000X Behavior AnalystLBA-1962MDYes

Practice location

6911 Laurel Bowie Rd
Bowie, MD 20715-1712

Phone 301-755-4021

Mailing address

7529 Standish Pl Ste 355
Derwood, MD 20855-2733

Phone 301-444-5001

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