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General NPI Number Information
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NPI Number | 1962701169
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Entity Type | Organization
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Legal Business Name | AUTISM INSTITUTE OF SOUTH CAROLINA, LLC
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 3924 FOREST DR SUITE #3
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City | COLUMBIA
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State | SC
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Zip | 29204-4150
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Country | US
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Telephone | 803-790-9975
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Fax |
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Provider Business Mailing Address
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Address Line | 3949 KENILWORTH RD
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City | COLUMBIA
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State | SC
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Zip | 29205-1503
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Country | US
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Telephone | 803-790-9975
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST-D
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Name | DR. PATRICIA ANN TALBERT MCCARTHY
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Credential | ED.D., BCBA-D
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Telephone | 803-790-9975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | BACB #1-06-3080
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License Number State |
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