Provider Demographics
NPI:1841541364
Name:PETRALIA-BUIE, ALLISON (BCBA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PETRALIA-BUIE
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6106
Mailing Address - Country:US
Mailing Address - Phone:803-361-6325
Mailing Address - Fax:
Practice Address - Street 1:800 PELHAM RD STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3300
Practice Address - Country:US
Practice Address - Phone:864-203-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst