Individual
MRS. LISA MIKLOSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
408 BONNEAU ST, BONNEAU, SC 29431-8625
(843) 810-6739
Mailing address
408 BONNEAU ST, BONNEAU, SC 29431-8625
(843) 810-6739
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-55430
SC
Other
Enumeration date
08/27/2018
Last updated
08/27/2018
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