Healthcare Provider Details

I. General information

NPI: 1407711971
Provider Name (Legal Business Name): CLAYTON THOMAS WEAVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E MAIN ST STE 200
ROCK HILL SC
29730-5384
US

IV. Provider business mailing address

731 MALLARD WAY
SENECA SC
29678-4974
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: