Provider Demographics
NPI:1477101814
Name:BLACKSTONE, LAUREN CAMPBELL (BCBA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:CAMPBELL
Last Name:BLACKSTONE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:SHARON
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 PROMISED LAND DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5702
Mailing Address - Country:US
Mailing Address - Phone:864-202-1500
Mailing Address - Fax:
Practice Address - Street 1:195 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1003
Practice Address - Country:US
Practice Address - Phone:864-202-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
SC1-23-66985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician