Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | SC |
NPI | 1104490077 |
---|---|
Provider Name | Ms. Shandy Latoya Skaggs |
First Address | Charleston, SC 29407-4125 |
Second Address | Charleston, SC 29407-4125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2021 |
Last Update Date | 16/05/2021 |