Healthcare Provider Details

I. General information

NPI: 1538832274
Provider Name (Legal Business Name): CHRYSTAL MARIE BOOTHE MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TRAIL RIDGE RD STE 100
AIKEN SC
29803-7765
US

IV. Provider business mailing address

2249 JOANN BRANCH RD
LAKE VIEW SC
29563-5555
US

V. Phone/Fax

Practice location:
  • Phone: 571-400-2860
  • Fax:
Mailing address:
  • Phone: 540-449-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003687
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: