Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003395567 |
---|---|
Provider Name | Regina Manfredi |
First Address | North Charleston, SC 29406-9254 |
Second Address | North Charleston, SC 29406-9254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2018 |
Last Update Date | 07/08/2018 |