Provider Demographics
NPI:1265143358
Name:MCGILL, FELICIA ALIECE (RBT)
Entity type:Individual
Prefix:MISS
First Name:FELICIA
Middle Name:ALIECE
Last Name:MCGILL
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 1:1505 BLANDING ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2906
Mailing Address - Country:US
Mailing Address - Phone:803-929-0011
Mailing Address - Fax:
Practice Address - Street 1:1505 BLANDING ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2906
Practice Address - Country:US
Practice Address - Phone:803-929-0011
Practice Address - Fax:803-569-1054
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22-246542103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC22-246542Medicaid