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Individual

MRS. STACEY MAE MICHAELS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
BCBA

Contact information

Practice address
418 PINCKNEY COLONY RD, OKATE, SC 29909
(843) 816-1789
Mailing address
418 PINCKNEY COLONY RD, OKATE, SC 29909
(843) 816-1789

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
222Q00000X
Developmental Therapist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
WP8916
SC
Enumeration date
08/22/2010
Last updated
10/17/2018
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