Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst |
NPI | 1003274481 |
---|---|
Provider Name | Krystina Mantzouranis |
First Address | Mount Pleasant, SC 29464-9753 |
Second Address | North Charleston, SC 29405-6861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2016 |
Last Update Date | 11/08/2019 |