Healthcare Provider Details

I. General information

NPI: 1568906394
Provider Name (Legal Business Name): BUILDING INDEPENDENCE TOGETHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3389 PRICES BRIDGE LN
WALTERBORO SC
29488-6983
US

IV. Provider business mailing address

3389 PRICES BRIDGE LN
WALTERBORO SC
29488-6983
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number11521189
License Number StateSC

VIII. Authorized Official

Name: MELISSA WILSON
Title or Position: PRESIDENT
Credential: LPC, BCABA
Phone: 843-934-1968