Healthcare Provider Details

I. General information

NPI: 1588580773
Provider Name (Legal Business Name): HEART OF GOLD AUTISM FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 CAMP DR STE B
LANCASTER SC
29720-8578
US

IV. Provider business mailing address

1016 KNOTTINGWOOD DR
LANCASTER SC
29720-2853
US

V. Phone/Fax

Practice location:
  • Phone: 803-804-9569
  • Fax:
Mailing address:
  • Phone: 803-804-9569
  • Fax: 803-804-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TARICA BROWN
Title or Position: CEO
Credential:
Phone: 980-330-9013