Provider Demographics
NPI:1447515507
Name:PALMETTO AUTISM INTERVENTIONS, LLC
Entity type:Organization
Organization Name:PALMETTO AUTISM INTERVENTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:J
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-929-1112
Mailing Address - Street 1:720 GRACERN RD
Mailing Address - Street 2:450
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7655
Mailing Address - Country:US
Mailing Address - Phone:803-929-1112
Mailing Address - Fax:
Practice Address - Street 1:720 GRACERN RD
Practice Address - Street 2:450
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7655
Practice Address - Country:US
Practice Address - Phone:803-929-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty