Provider Demographics
NPI:1194498147
Name:HART, TRACI (RBT)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 ASHLEY PHOSPHATE RD STE B11
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6406
Mailing Address - Country:US
Mailing Address - Phone:843-813-1538
Mailing Address - Fax:
Practice Address - Street 1:2810 ASHLEY PHOSPHATE RD STE B11
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6406
Practice Address - Country:US
Practice Address - Phone:843-813-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-21-175975106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician