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General NPI Number Information
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NPI Number | 1033074992
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Entity Type | Individual
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Provider Name | JAILAH MONIQUE WOLLEY
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Gender | Female
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 3029 FIVE CHOP RD
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City | ORANGEBURG
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State | SC
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Zip | 29115-9680
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Country | US
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Telephone | 803-937-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 255 FRESNO CT
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City | ORANGEBURG
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State | SC
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Zip | 29118-9295
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Country | US
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Telephone | 803-220-7266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | SC
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