Individual
TIMARA NICOLE MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
491 CHAPMAN RD LOT 111, FOUNTAIN INN, SC 29644-6139
(843) 408-5798
Mailing address
166 SOUTHPORT DR, SUMMERVILLE, SC 29483-7082
(843) 408-5798
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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