Individual
NICOLE DIVINCENZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
1099 PLAYGROUND RD, CHARLESTON, SC 29407-6465
(843) 573-2111
Mailing address
4976 WESCOTT BLVD APT 131, SUMMERVILLE, SC 29485-9021
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-19-10456
SC
Other
Enumeration date
01/09/2020
Last updated
01/09/2020
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