Healthcare Provider Details

I. General information

NPI: 1992120307
Provider Name (Legal Business Name): SHAWNA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 SAM RITTENBERG BLVD STE 1B
CHARLESTON SC
29407-4125
US

IV. Provider business mailing address

1529 SAM RITTENBERG BLVD STE 1B
CHARLESTON SC
29407-4125
US

V. Phone/Fax

Practice location:
  • Phone: 888-547-2250
  • Fax:
Mailing address:
  • Phone: 888-547-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: