Healthcare Provider Details

I. General information

NPI: 1538064845
Provider Name (Legal Business Name): MISS CHLOE ELIZABETH MONTGOMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1426 MAIN ST APT 1007
COLUMBIA SC
29201-5841
US

IV. Provider business mailing address

246 TEDDY BEAR CIR
CONWAY SC
29526-9924
US

V. Phone/Fax

Practice location:
  • Phone: 843-516-2930
  • Fax:
Mailing address:
  • Phone: 843-516-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: