Healthcare Provider Details

I. General information

NPI: 1710635123
Provider Name (Legal Business Name): ANGEL OBANNER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 ASHLEY RIVER RD UNIT 80901B
CHARLESTON SC
29416-1637
US

IV. Provider business mailing address

1964 ASHLEY RIVER RD UNIT 80901B
CHARLESTON SC
29416-1637
US

V. Phone/Fax

Practice location:
  • Phone: 803-372-7343
  • Fax: 888-808-4249
Mailing address:
  • Phone: 803-372-7343
  • Fax: 888-808-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: