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General NPI Number Information
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NPI Number | 1356211130
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Entity Type | Organization
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Legal Business Name | PBS
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 3630 RANCH RD
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City | COLUMBIA
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State | SC
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Zip | 29206-5252
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Country | US
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Telephone | 484-645-5975
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Fax |
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Provider Business Mailing Address
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Address Line | 3630 RANCH RD
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City | COLUMBIA
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State | SC
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Zip | 29206-5252
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Country | US
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Telephone | 484-645-5975
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Fax |
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Authorized Official
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Title or Position | ASSISTANT
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Name | HASSAN LUCAS
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Credential |
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Telephone | 484-645-5975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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