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NPI Code Detail

MEDICARE: CRESCENT CHILD DEVELOPMENT SERVICES, LLC

MEDICARE: CRESCENT CHILD DEVELOPMENT SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106E00000XAssistant Behavior Analyst
2235Z00000XSpeech-Language Pathologist2212SC
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1720514938
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESCENT CHILD DEVELOPMENT SERVICES, LLC
Provider Business Mailing Address
First Line : 966 GOVERNORS CT
Second Line : MOUNT PLEASANT
City : MOUNT PLEASANT
State : SC
Zip : 29464-9257
Country : US
Telephone Number : 843-813-1538
Fax Number : 888-813-3318
Provider Business Practice Location Address
First Line : 2810 ASHLEY PHOSPHATE RD
Second Line : B-11
City : NORTH CHARLESTON
State : SC
Zip : 29418-6405
Country : US
Telephone Number : 843-813-1538
Fax Number : 888-813-3318
Authorized Official
Title or Position : OWNER/DIRECTOR
Name : MS. TARA MARIE GREGORI
Credential :
Telephone Number : 843-813-1538
Provider Enumeration Date : 05/08/2017
Last Update Date : 05/08/2017

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Directions to “CRESCENT CHILD DEVELOPMENT SERVICES, LLC ” Practice Location

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