Healthcare Provider Details

I. General information

NPI: 1932872512
Provider Name (Legal Business Name): GAETANINA SMITH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 GLEN ST
SUMMERVILLE SC
29483-4653
US

IV. Provider business mailing address

328 GLEN ST
SUMMERVILLE SC
29483-4653
US

V. Phone/Fax

Practice location:
  • Phone: 843-934-1968
  • Fax: 888-298-0519
Mailing address:
  • Phone: 843-934-1968
  • Fax: 888-298-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-51882
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: