Individual
SHANNEL ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
460 PIN OAK DR, LEXINGTON, SC 29073-7916
(803) 714-3446
Mailing address
460 PIN OAK DR, LEXINGTON, SC 29073-7916
(803) 714-3446
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-117322
—
Other
Enumeration date
08/24/2020
Last updated
08/24/2020
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