Provider Demographics
NPI:1992063275
Name:BEHAVIORAL DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:BEHAVIORAL DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:843-509-6819
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059-1481
Mailing Address - Country:US
Mailing Address - Phone:843-509-6819
Mailing Address - Fax:803-496-7237
Practice Address - Street 1:108 STAGECOACH LN
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2499
Practice Address - Country:US
Practice Address - Phone:843-509-6819
Practice Address - Fax:803-496-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0082Medicaid