Individual
COREY BLAGSVEDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
2413 SAVANNAH HWY, CHARLESTON, SC 29414-5323
(843) 449-0554
Mailing address
1508 AZALEA DR, MYRTLE BEACH, MYRTLE BEACH, SC, SC 29575
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
17-38371
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
07/16/2021
Last updated
07/16/2021
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