Provider Demographics
NPI:1700275229
Name:ALLEN, TABATHA DEAS (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:DEAS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 GOVERNORS CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9257
Mailing Address - Country:US
Mailing Address - Phone:843-813-1538
Mailing Address - Fax:
Practice Address - Street 1:2810 ASHLEY PHOSPHATE RD STE B11
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6406
Practice Address - Country:US
Practice Address - Phone:843-813-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0-14-6299106E00000X
SC1-21-48578103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCBB1018Medicaid