=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679392369
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN HOPPER RBT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2024
-----------------------------------------------------
Last Update Date | 10/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8310 RIVERS AVE STE D
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-9268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-588-5677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8674 WINDSOR HILL BLVD
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29420-8458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-588-5677
-----------------------------------------------------
Fax | 855-632-2877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | RBT-24-349924
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------