Healthcare Provider Details

I. General information

NPI: 1144076308
Provider Name (Legal Business Name): AUTUMN CHANDLER HAWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CREEKVIEW CT
GREENVILLE SC
29615-4800
US

IV. Provider business mailing address

1764 TREE BLVD STE 2
ST AUGUSTINE FL
32084-5723
US

V. Phone/Fax

Practice location:
  • Phone: 864-609-4108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2853219
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: