Healthcare Provider Details

I. General information

NPI: 1568624104
Provider Name (Legal Business Name): CHRYSALIS AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 OAKLAND AVE STE 101
ROCK HILL SC
29730
US

IV. Provider business mailing address

1547 CHERRY RD
ROCK HILL SC
29732-2616
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0-04-1396
License Number StateSC

VIII. Authorized Official

Name: MRS. TOBEN F. PRESLER
Title or Position: PRESIDENT
Credential: BCABA
Phone: 803-367-2261