Provider Demographics
NPI:1083230791
Name:MCBRIDE-TOBIERE, ATIANA
Entity Type:Individual
Prefix:
First Name:ATIANA
Middle Name:
Last Name:MCBRIDE-TOBIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 LANGSTON ST
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-9310
Mailing Address - Country:US
Mailing Address - Phone:803-464-7202
Mailing Address - Fax:
Practice Address - Street 1:1915 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1013
Practice Address - Country:US
Practice Address - Phone:803-366-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7231235Z00000X
NC15014235Z00000X
SC7584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist