Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-10121 | SC |
NPI | 1043852924 |
---|---|
Provider Name | Melanie Denise Blackwell |
First Address | Lexington, SC 29073-7916 |
Second Address | Lexington, SC 29073-7916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2019 |
Last Update Date | 12/10/2019 |