Provider Demographics
NPI:1285180455
Name:RAINES, MIA ALANA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:ALANA
Last Name:RAINES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:THOMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 DUNNOCK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9525
Mailing Address - Country:US
Mailing Address - Phone:803-546-6922
Mailing Address - Fax:
Practice Address - Street 1:15 DUNNOCK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9525
Practice Address - Country:US
Practice Address - Phone:803-546-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-17-28107103K00000X
NC590103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty