Active NPI
Agnieszka Balawender
- Behavior Technician
- Mt Pleasant, SC
National Provider Identifier
1104334028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 17-38925
- Practice address
- 1123 Queensborough Blvd Ste 102
Mt Pleasant, SC 29464-3682 - Phone
- (843) 352-7049
- NPI assigned
- Jan 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 17-38925 | SC | Primary |
Addresses
Primary practice location
1123 Queensborough Blvd Ste 102
Mt Pleasant, SC 29464-3682
Mailing address
181 W Professional Park CT Ste 1
Bowling Green, KY 42104-3250
Phone (270) 777-9283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17-38925 | SC | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Counseling Services | Past | Accepting new patients | |
| Community Living in Kentucky, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Murray, KY
- NPI 1518281419
-
- Community/Behavioral Health Agency
- Bowling Green, KY
- NPI 1508278458
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515715200000",
"number": "1104334028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "181 W PROFESSIONAL PARK CT STE 1",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421043250",
"telephone_number": "270-777-9283",
"fax_number": "270-777-9283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1123 QUEENSBOROUGH BLVD STE 102",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294643682",
"telephone_number": "843-352-7049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALAWENDER",
"first_name": "AGNIESZKA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-12",
"last_updated": "2018-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "SC",
"license": "17-38925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.