Provider Demographics
NPI:1215392337
Name:AUTISM SERVICES OF SOUTH CAROLINA
Entity type:Organization
Organization Name:AUTISM SERVICES OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-212-8971
Mailing Address - Street 1:PO BOX 5715
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-5715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 WOODROW ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1229
Practice Address - Country:US
Practice Address - Phone:803-212-8971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty