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200 S Herlong Ave Suite C Rock Hill SC 29732-3399 | |
| (803) 323-2775 | |
| (803) 325-2484 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 200 S Herlong Ave, Rock Hill, South Carolina |
| Authorized Official Name and Position | Wesley O. James (REGIONAL CFO, TENET) |
| Authorized Official Contact | 4042655009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 402368 Atlanta GA 30384-2368 Ph: (803) 323-2775 | 200 S Herlong Ave Suite C Rock Hill SC 29732-3399 Ph: (803) 323-2775 |
| NPI Number | 1265661763 |
|---|---|
| Provider Enumeration Date | 07/07/2009 |
| Last Update Date | 06/16/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265661763 | NPI | - | NPPES |
| GP5269 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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