Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 17-38456 | SC |
NPI | 1003305426 |
---|---|
Provider Name | Lara Dabaibeh |
First Address | Sumter, SC 29150-1832 |
Second Address | Greenville, SC 29615-3170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2018 |
Last Update Date | 02/05/2018 |