Individual
TERRISSA ASIANAE STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 MAIN ST STE 300, COLUMBIA, SC 29201-3266
(877) 418-2978
(866) 500-2186
Mailing address
4575 SE DIXIE HWY, STUART, FL 34997-6826
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
SC
Other
Enumeration date
12/17/2020
Last updated
11/08/2021
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