Healthcare Provider Details

I. General information

NPI: 1508780149
Provider Name (Legal Business Name): EMILY GRACE GIBBONS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3668 N WILLIAMSBURG COUNTY HWY
CADES SC
29518-3009
US

IV. Provider business mailing address

3668 N WILLIAMSBURG COUNTY HWY
CADES SC
29518-3009
US

V. Phone/Fax

Practice location:
  • Phone: 843-389-2125
  • Fax: 843-389-2126
Mailing address:
  • Phone: 843-389-2125
  • Fax: 843-389-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-529358
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: