Healthcare Provider Details

I. General information

NPI: 1972037885
Provider Name (Legal Business Name): BEHAVIOR AND EDUCATIONAL SUPPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 INDIGO AVE
CAYCE SC
29033-3214
US

IV. Provider business mailing address

1208 INDIGO AVE
CAYCE SC
29033-3214
US

V. Phone/Fax

Practice location:
  • Phone: 803-873-1920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: VERONICA MCNEAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-873-1920