| NPI | 1649778036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRAINE TAVAREZ LOPEZ Owner 803-900-4849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: SC 4657) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 102L00000X Psychoanalyst | |
| 103K00000X Behavior Analyst | |
| 103TS0200X Psychologist, School (Licence: SC 4657) | |
| 106E00000X Assistant Behavior Analyst | |
| 106S00000X Behavior Technician | |
| 235Z00000X Speech-Language Pathologist, | |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2019-06-05 |