Provider Demographics
NPI:1184449076
Name:ESPINOSA, ZACHARY ETHAN (RBT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ETHAN
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WINSHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7460
Mailing Address - Country:US
Mailing Address - Phone:803-923-0170
Mailing Address - Fax:803-923-0170
Practice Address - Street 1:825 WINSHAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7460
Practice Address - Country:US
Practice Address - Phone:803-923-0170
Practice Address - Fax:803-923-0170
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-24-391760106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician