Healthcare Provider Details

I. General information

NPI: 1922948496
Provider Name (Legal Business Name): DEMI A. MENITT RBT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 6TH BAXTER XING STE B
FORT MILL SC
29708-6596
US

IV. Provider business mailing address

16255 VENTURA BLVD
ENCINO CA
91436-2302
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-526217
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: