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General NPI Number Information
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NPI Number | 1700275229
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Entity Type | Individual
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Provider Name | TABATHA DEAS ALLEN BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 2810 ASHLEY PHOSPHATE RD STE B11
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-6406
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Country | US
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Telephone | 843-813-1538
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Fax |
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Provider Business Mailing Address
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Address Line | 966 GOVERNORS CT
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-9257
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Country | US
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Telephone | 843-813-1538
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0-14-6299
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-48578
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License Number State | SC
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