Provider Demographics
NPI:1295558013
Name:HARRIOTT, GRACIE KENDALL (RBT)
Entity type:Individual
Prefix:
First Name:GRACIE
Middle Name:KENDALL
Last Name:HARRIOTT
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 1:3319 ARGENT BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-3266
Mailing Address - Country:US
Mailing Address - Phone:978-545-0074
Mailing Address - Fax:
Practice Address - Street 1:3319 ARGENT BLVD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-3266
Practice Address - Country:US
Practice Address - Phone:978-545-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician