Provider / Organization | NPI | Date Certified |
---|---|---|
JACQUAVIOUS DESHAWN BURT | 1205564440 | 2022-08-14 |
Jacquavious Deshawn Burt is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1205564440. Registration indicates Jacquavious Deshawn Burt is a provider of services with a specialization in Behavioral Health & Social Service Providers, Behavior Technician (Behavior Technician, Behavioral Health & Social Service Providers) (Behavior Technician, )
Entity Type | Individual |
Provider Name | Jacquavious Deshawn Burt |
Practice Office Address | 6296 BRIDGEPORT VILLAGE SQUARE DR STE 2 BRIDGEPORT, MI US |
Practice Office Telephone | 9894011239 |
Mailing Address | 5039 VILLA LINDE PKWY STE 30 FLINT, MI 485323450 US |
Business Telephone | 9894012244 |
Code | Practice | License No State |
---|---|---|
106S00000X PRIMARY | Behavioral Health & Social Service Providers Behavior Technician Behavior Technician Behavioral Health & Social Service Providers Behavior Technician | 630356139055
MI |