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NPI 1396137584

NPI 1396137584 : AUTISM AND BEYOND : NORTH CHARLESTON, SC

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General NPI Number Information
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    NPI Number           |    1396137584
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    Entity Type          |    Organization 
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    Legal Business Name  |    AUTISM AND BEYOND 
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Dates
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    Enumeration Date     |    02/24/2015
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    Last Update Date     |    04/03/2017
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Provider Practice Location Address
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    Address Line         |    3236 LANDMARK DR SUITE 103
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    City                 |    NORTH CHARLESTON
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    State                |    SC
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    Zip                  |    29418-8488
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    Country              |    US
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    Telephone            |    843-359-3326
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    3236 LANDMARK DR SUITE 103
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    City                 |    NORTH CHARLESTON
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    State                |    SC
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    Zip                  |    29418-8488
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    Country              |    US
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    Telephone            |    843-359-3326
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    Fax                  |    
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Authorized Official
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    Title or Position    |    CLIINICAL DIRECTOR
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    Name                 |    MRS. STEPHANIE BURCHFIELD BURGESS 
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    Credential           |    BCBA
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    Telephone            |    843-359-3326
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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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Taxonomy #2
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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 |    
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Taxonomy #3
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    Taxonomy Code        |    103K00000X
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    Taxonomy Name        |    Behavior Analyst
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    License Number       |    
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    License Number State |    
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