Healthcare Provider Details

I. General information

NPI: 1063030567
Provider Name (Legal Business Name): ZACARIA TERRY BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 PELHAM RD
GREENVILLE SC
29615-5044
US

IV. Provider business mailing address

209B DOUGLAS DR
SIMPSONVILLE SC
29681-6010
US

V. Phone/Fax

Practice location:
  • Phone: 864-336-3790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-11173
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: