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General NPI Number Information
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NPI Number | 1730563313
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Entity Type | Individual
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Provider Name | ANSLIE CALLAWAY PATRICK BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 1505 BLANDING ST
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City | COLUMBIA
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State | SC
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Zip | 29201
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Country | US
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Telephone | 912-536-2002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7514
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City | COLUMBIA
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State | SC
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Zip | 29202-7514
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Country | US
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Telephone | 912-536-2002
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-33044
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License Number State |
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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 | 0-15-6598
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License Number State | GA
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