Active NPI
Cordelia Elizabeth Dallam, LBA
- Behavior Analyst
- Charleston, SC
National Provider Identifier
1386469096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 004676-01
- Practice address
- 2049 Savannah Hwy Ste D
Charleston, SC 29407-2228 - Phone
- (315) 992-1929
- NPI assigned
- Nov 18, 2024
- Last updated
- Aug 3, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-25-86171 | NU | |
| Behavior Analyst | 103K00000X | 004676-01 | NY | Primary |
Addresses
Primary practice location
2049 Savannah Hwy Ste D
Charleston, SC 29407-2228
Mailing address
122 Harvey Ave
Goose Creek, SC 29445-4208
Phone (913) 313-5407
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 |
|---|---|---|---|
| 004676-01 | NY | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785715200000",
"number": "1386469096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 HARVEY AVE",
"city": "GOOSE CREEK",
"state": "SC",
"postal_code": "294454208",
"telephone_number": "913-313-5407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2049 SAVANNAH HWY STE D",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294072228",
"telephone_number": "315-992-1929"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALLAM",
"first_name": "CORDELIA",
"middle_name": "ELIZABETH",
"credential": "LBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-18",
"last_updated": "2026-08-03",
"certification_date": "2026-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": "1-25-86171",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NY",
"license": "004676-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
- Jeana Dealene Dale, LCSW
- Dane Nicholas Daley, M.D.
- Kristin A Daley, MD
- Leigh Watrobski Daley, P.A.
- Jacqueline Dallaire, MD
- Dallas Southeast Long Term Acute Care, LLC (Progressive Hospital of Dallas)
- Brett Raul Dalmau, PA-C
- Kimberly Hall Dalmau, DNP, FNP-C
- Dustin Dalton, M.D.
- Charles Andrew Daly, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.