Healthcare Provider Details

I. General information

NPI: 1063316883
Provider Name (Legal Business Name): RENEE LATHAM BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WICKER PARK AVE
GREER SC
29651-1948
US

IV. Provider business mailing address

6103 CINELLI ST
GREENVILLE SC
29615-4280
US

V. Phone/Fax

Practice location:
  • Phone: 865-659-5476
  • Fax:
Mailing address:
  • Phone: 865-659-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2854642
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: