Healthcare Provider Details

I. General information

NPI: 1396137584
Provider Name (Legal Business Name): AUTISM AND BEYOND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 LANDMARK DR SUITE 103
NORTH CHARLESTON SC
29418-8488
US

IV. Provider business mailing address

3236 LANDMARK DR SUITE 103
NORTH CHARLESTON SC
29418-8488
US

V. Phone/Fax

Practice location:
  • Phone: 843-359-3326
  • Fax:
Mailing address:
  • Phone: 843-359-3326
  • Fax:

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: MRS. STEPHANIE BURCHFIELD BURGESS
Title or Position: CLIINICAL DIRECTOR
Credential: BCBA
Phone: 843-359-3326