Provider Demographics
NPI:1235451535
Name:WARDELL, DEBORAH ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:WARDELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 AUBURN LN APT 19C
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-5157
Mailing Address - Country:US
Mailing Address - Phone:843-424-1129
Mailing Address - Fax:
Practice Address - Street 1:950 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9726
Practice Address - Country:US
Practice Address - Phone:843-884-7144
Practice Address - Fax:843-416-8768
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst