Provider Demographics
NPI:1417694407
Name:LAURENDEAU, EMILIE KATHRYN (RBT)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:KATHRYN
Last Name:LAURENDEAU
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6934
Mailing Address - Country:US
Mailing Address - Phone:803-394-5619
Mailing Address - Fax:803-339-1907
Practice Address - Street 1:3401 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6934
Practice Address - Country:US
Practice Address - Phone:803-394-5619
Practice Address - Fax:803-339-1907
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-215422106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRBT-22-215422OtherBEHAVIOR ANALYST CERTIFICATION BOARD (RBT)