Provider Demographics
NPI:1255028833
Name:LINER, PAYTON MACKENZIE
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:MACKENZIE
Last Name:LINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 KING ST APT 215
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6946
Mailing Address - Country:US
Mailing Address - Phone:864-263-0441
Mailing Address - Fax:
Practice Address - Street 1:595 KING ST APT 215
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-6946
Practice Address - Country:US
Practice Address - Phone:864-263-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst