Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1023591179 |
---|---|
Provider Name | Laura Shields |
First Address | Woodruff, SC 29388-8787 |
Second Address | Woodruff, SC 29388-8787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2018 |
Last Update Date | 28/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
58-2324540 | (05) | SC |
BB1047 | (05) | SC |