Healthcare Provider Details

I. General information

NPI: 1326631748
Provider Name (Legal Business Name): KEONDRE DEFLANDERS MS, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SCIENCE CT
COLUMBIA SC
29203-9344
US

IV. Provider business mailing address

514 STERLING PONDS DR
BLYTHEWOOD SC
29016-9698
US

V. Phone/Fax

Practice location:
  • Phone: 803-866-5439
  • Fax:
Mailing address:
  • Phone: 803-866-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2853414
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: