Healthcare Provider Details

I. General information

NPI: 1386151280
Provider Name (Legal Business Name): ANDREA HEATHER CORUM BARNHART BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 11/01/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W BUTLER ST
LEXINGTON SC
29072-2605
US

IV. Provider business mailing address

460 PIN OAK DR
LEXINGTON SC
29073-7916
US

V. Phone/Fax

Practice location:
  • Phone: 803-714-3446
  • Fax:
Mailing address:
  • Phone: 803-714-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50938
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-26262
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: