Provider Demographics
NPI:1285180455
Name:RAINES, MIA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:THOMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 STEPHANEE LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-9408
Mailing Address - Country:US
Mailing Address - Phone:803-546-6922
Mailing Address - Fax:
Practice Address - Street 1:110 STEPHANEE LN
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:SC
Practice Address - Zip Code:29130-9408
Practice Address - Country:US
Practice Address - Phone:803-546-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst