Provider Demographics
NPI:1720450539
Name:GEORGIADES, MARY BETH (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:GEORGIADES
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 1:177 RIVER GREEN PL
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7305
Mailing Address - Country:US
Mailing Address - Phone:843-654-5000
Mailing Address - Fax:
Practice Address - Street 1:177 RIVER GREEN PL
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7305
Practice Address - Country:US
Practice Address - Phone:843-654-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst