Provider Demographics
NPI:1720648413
Name:LINOG, LAURIE ANGELI (BCBA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANGELI
Last Name:LINOG
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 1:2934 SUGARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-6708
Mailing Address - Country:US
Mailing Address - Phone:803-306-3085
Mailing Address - Fax:
Practice Address - Street 1:2340 TREESCAPE DR APT 8
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6580
Practice Address - Country:US
Practice Address - Phone:843-532-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty