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General NPI Number Information
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NPI Number | 1568624104
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Entity Type | Organization
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Legal Business Name | CHRYSALIS AUTISM CENTER
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 410 OAKLAND AVE STE 101
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City | ROCK HILL
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State | SC
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Zip | 29730
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Country | US
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Telephone | 803-792-0771
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Fax | 803-656-0764
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Provider Business Mailing Address
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Address Line | 1547 CHERRY RD
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City | ROCK HILL
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State | SC
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Zip | 29732-2616
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Country | US
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Telephone | 803-792-0771
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TOBEN F. PRESLER
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Credential | BCABA
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Telephone | 803-367-2261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0-04-1396
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License Number State | SC
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