Full Spectrum ABA of South Carolina LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

FULL SPECTRUM ABA OF SOUTH CAROLINA LLC

Practice address

6650 Rivers Ave Ste 100
North Charleston, SC 29406-4809

Phone

(813) 926-5454

NPI assigned

Nov 4, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Collin Edward Streetman, BCBA

Title

Owner

Phone

(813) 926-5454

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574208000000",
    "number": "1063056828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6650 RIVERS AVE STE 100",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294064809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6650 RIVERS AVE STE 100",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294064809",
            "telephone_number": "813-926-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SPECTRUM ABA OF SOUTH CAROLINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-04",
        "last_updated": "2019-11-20",
        "status": "A",
        "authorized_official_last_name": "STREETMAN",
        "authorized_official_first_name": "COLLIN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-926-5454",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Behavior Analyst in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.