Individual
MELANIE DENISE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
460 PIN OAK DR, LEXINGTON, SC 29073-7916
(803) 369-7116
(803) 824-6189
Mailing address
460 PIN OAK DR, LEXINGTON, SC 29073-7916
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-19-10121
SC
Other
Enumeration date
10/12/2019
Last updated
10/12/2019
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