Provider Demographics
NPI:1508031006
Name:SPECTRUM, THERAPY, ASSESSMENT, REHABILITATION
Entity Type:Organization
Organization Name:SPECTRUM, THERAPY, ASSESSMENT, REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:ZAHRA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:HAJIAGHAMOHSENI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:843-532-8349
Mailing Address - Street 1:246 CAROLINIAN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7854
Mailing Address - Country:US
Mailing Address - Phone:949-322-6316
Mailing Address - Fax:
Practice Address - Street 1:246 CAROLINIAN DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7854
Practice Address - Country:US
Practice Address - Phone:949-322-6316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2008-071908103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty