Provider Demographics
NPI:1972178754
Name:ABLAN, AMANDA NICOLE (RBT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:ABLAN
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 1:1964 ASHLEY RIVER RD UNIT 80901B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-1637
Mailing Address - Country:US
Mailing Address - Phone:678-761-0279
Mailing Address - Fax:888-808-4249
Practice Address - Street 1:1964 ASHLEY RIVER RD UNIT 80901B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29416-1637
Practice Address - Country:US
Practice Address - Phone:678-761-0279
Practice Address - Fax:888-808-4249
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician