Individual
LAUREN VAN WIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS BCBA
Contact information
Practice address
1706 MILL POND RD STE B, CONWAY, SC 29527-4745
(843) 488-9009
Mailing address
2131 EDDY RD, CONWAY, SC 29526-8186
(848) 525-3517
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-47983
SC
Other
Enumeration date
05/02/2021
Last updated
05/02/2021
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