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General NPI Number Information
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NPI Number | 1487160602
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Entity Type | Organization
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Legal Business Name | BARDIN BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 3401 COLONIAL DR
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City | COLUMBIA
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State | SC
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Zip | 29203-6934
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Country | US
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Telephone | 803-394-5619
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Fax | 803-339-1907
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Provider Business Mailing Address
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Address Line | 3401 COLONIAL DR
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City | COLUMBIA
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State | SC
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Zip | 29203-6934
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Country | US
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Telephone | 803-394-5619
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Fax | 803-339-1907
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Authorized Official
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Title or Position | BEHAVIOR ANALYST AND OWNER
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Name | THOMAS JOSEPH BARDIN III
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Credential | BCBA
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Telephone | 803-394-5619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-28411
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License Number State |
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