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Individual

SHANTEL ALTHEA BULLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RBT

Contact information

Practice address
716 ZIMALCREST DR APT 2314, COLUMBIA, SC 29210-6582
(404) 924-6220
Mailing address
716 ZIMALCREST DR APT 2314, COLUMBIA, SC 29210-6582
(404) 924-6220

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-314405
SC

Other

Enumeration date
12/04/2025
Last updated
12/04/2025
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