Individual
MICHELLE CRISTINA MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3410 SUNSET BLVD, WEST COLUMBIA, SC 29169-3042
(864) 757-9918
(964) 757-9921
Mailing address
1278 ANCRUM FERRY RD, LUGOFF, SC 29078-9604
(803) 529-2963
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-58473
—
Other
Enumeration date
01/16/2018
Last updated
12/29/2022
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