Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 104100000X | Social Worker | 12205 | SC |
NPI | 1003120817 |
---|---|
Provider Name | Chelsea Lee Cruise |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 10/10/2018 |