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Cognitive and Behavioral

Aiken, South Carolina

Provider NPI: 1174740625

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 803-642-1085  Fax: --

Business Mailing Address:
Tel: 803-644-1532  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103TB0200XBehavioral Health & Social Service Providers
Cognitive & Behavioral

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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