Individual
THERESA CORDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
714 CAROLINA AVE, NORTH AUGUSTA, SC 29841-3434
(706) 842-5330
(706) 842-5340
Mailing address
3736 EXECUTIVE CENTER DR, AUGUSTA, GA 30907-2360
(706) 842-5330
(706) 842-5340
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-113951
SC
Other
Enumeration date
07/14/2021
Last updated
07/14/2021
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