Healthcare Provider Details

I. General information

NPI: 1831595321
Provider Name (Legal Business Name): AUBREY WISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUBREY MIRANDA GONZALEZ

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 CALHOUN ST STE 202
COLUMBIA SC
29201-2406
US

IV. Provider business mailing address

1022 CALHOUN ST STE 202
COLUMBIA SC
29201-2406
US

V. Phone/Fax

Practice location:
  • Phone: 803-335-0718
  • Fax:
Mailing address:
  • Phone: 803-335-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58373
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-14-6059
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: