Provider Demographics
NPI:1942836317
Name:WILLIAMS, TAYLOR BREANNA (BCABA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BREANNA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 GERALD DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4111
Mailing Address - Country:US
Mailing Address - Phone:864-757-9918
Mailing Address - Fax:864-757-9921
Practice Address - Street 1:511 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4890
Practice Address - Country:US
Practice Address - Phone:864-757-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0-20-10989106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0-20-10989OtherBACB- BEHAVIOR ANALYST CERIFICATION BOARD