Individual
STACIE MARIE DIZZLEY-STREETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
194 CYPRESS FOREST DR, MONCKS CORNER, SC 29461-8441
(803) 459-8022
(615) 577-5654
Mailing address
194 CYPRESS FOREST DR, MONCKS CORNER, SC 29461-8441
(803) 459-8022
(615) 577-5654
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-27316
NC
Other
Enumeration date
09/23/2016
Last updated
01/25/2023
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