Organization
BLOSSOM BEHAVIOR CONSULTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GRETCHEN BENTZ FRICKER BCBA (BEHAVIOR ANALYST)
(305) 394-9379
Entity
Organization
Contact information
Practice address
620 CLEARVIEW DR, CHARLESTON, SC 29412-4544
(305) 394-9379
Mailing address
620 CLEARVIEW DR, CHARLESTON, SC 29412-4544
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
05
—
PENDING
—
SC
Enumeration date
08/02/2017
Last updated
08/02/2017
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