Individual
MYRA LYNN RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
222 RED BANK RD, GOOSE CREEK, SC 29445-4502
(843) 628-2935
Mailing address
PO BOX 1667, GOOSE CREEK, SC 29445-1667
(843) 628-2935
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-324366
SC
Other
Enumeration date
10/03/2024
Last updated
10/03/2024
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