Provider Demographics
NPI:1174021919
Name:FIGUEROA, MIRRANDA
Entity Type:Individual
Prefix:
First Name:MIRRANDA
Middle Name:
Last Name:FIGUEROA
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 1:625 SOAP STONE RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-5946
Mailing Address - Country:US
Mailing Address - Phone:864-514-9307
Mailing Address - Fax:
Practice Address - Street 1:301 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3122
Practice Address - Country:US
Practice Address - Phone:864-336-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-21-12788106E00000X
SC17-41044106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst