Healthcare Provider Details

I. General information

NPI: 1720913742
Provider Name (Legal Business Name): ABELLA GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MAIN ST # 230
NORTH MYRTLE BEACH SC
29582-3030
US

IV. Provider business mailing address

4975 HIGHWAY 701 N
CONWAY SC
29526-5799
US

V. Phone/Fax

Practice location:
  • Phone: 813-763-5469
  • Fax:
Mailing address:
  • Phone: 843-798-2991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-544982
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: