Healthcare Provider Details

I. General information

NPI: 1124742390
Provider Name (Legal Business Name): MONICA POLANCO DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 EBENEZER RD STE A
ROCK HILL SC
29732-1015
US

IV. Provider business mailing address

2051 EBENEZER RD STE A
ROCK HILL SC
29732-1015
US

V. Phone/Fax

Practice location:
  • Phone: 803-386-7523
  • Fax:
Mailing address:
  • Phone: 803-386-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17120
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: