Individual
MAXIMUS GORDON PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10 ARBORLAND WAY, GREENVILLE, SC 29615-2201
(864) 520-1614
Mailing address
115 HEATHER DR, SPARTANBURG, SC 29301-5465
(843) 494-4629
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-306010
SC
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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