Provider Demographics
NPI:1386151280
Name:CORUM BARNHART, ANDREA HEATHER (BCBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:HEATHER
Last Name:CORUM BARNHART
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7916
Mailing Address - Country:US
Mailing Address - Phone:803-714-3446
Mailing Address - Fax:
Practice Address - Street 1:333 W BUTLER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2605
Practice Address - Country:US
Practice Address - Phone:803-714-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16-26262106S00000X
SC1-21-50938103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician