Individual
BANIBAJA CLHAVINZKY SILALAHI LAGUATAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1711 CENTRAL AVE, SUMMERVILLE, SC 29483-9320
(843) 460-2605
Mailing address
328 GLEN ST, SUMMERVILLE, SC 29483-4653
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-217639
CO
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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