Provider Demographics
NPI:1609699230
Name:POWELL, YOLANDA NICOLE (RBT)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:NICOLE
Last Name:POWELL
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 1:331 HARBOR ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8896
Mailing Address - Country:US
Mailing Address - Phone:425-900-7126
Mailing Address - Fax:843-989-0112
Practice Address - Street 1:331 HARBOR ISLAND DR APT 110
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8897
Practice Address - Country:US
Practice Address - Phone:425-900-7126
Practice Address - Fax:843-989-0112
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRBT-24-375697SOtherRBT: BACB CERT#