Healthcare Provider Details

I. General information

NPI: 1396275806
Provider Name (Legal Business Name): CHRYSALIS AUTISM CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2017
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 CHERRY RD
ROCK HILL SC
29732
US

IV. Provider business mailing address

410 OAKLAND AVE STE 101
ROCK HILL SC
29730-3530
US

V. Phone/Fax

Practice location:
  • Phone: 802-792-0771
  • Fax: 803-656-0764
Mailing address:
  • Phone: 803-792-0771
  • Fax: 803-656-0764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TOBEN PRESLER
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 803-792-0771