Individual
LAURA SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
751 E GEORGIA RD, WOODRUFF, SC 29388-8787
(864) 476-7400
Mailing address
751 E GEORGIA RD, WOODRUFF, SC 29388-8787
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106E00000X
Assistant Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58-2324540
—
SC
05
—
BB1047
—
SC
Enumeration date
09/13/2018
Last updated
03/28/2019
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