Healthcare Provider Details

I. General information

NPI: 1326964149
Provider Name (Legal Business Name): LAURYN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 PENDLETON ST
COLUMBIA SC
29208-4109
US

IV. Provider business mailing address

1501 PENDLETON ST
COLUMBIA SC
29208-4109
US

V. Phone/Fax

Practice location:
  • Phone: 843-956-3675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-304405
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: