Healthcare Provider Details

I. General information

NPI: 1568399210
Provider Name (Legal Business Name): POSITIVE BEHAVIOR SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

112 DOVE RD
GREENWOOD SC
29649-8808
US

V. Phone/Fax

Practice location:
  • Phone: 864-980-4947
  • Fax:
Mailing address:
  • Phone: 864-980-4947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MISS FAITH HOLLY
Title or Position: CLINICAL TRAINING COORDINATOR
Credential:
Phone: 855-832-6727