Provider Demographics
NPI:1144019290
Name:YELDELL, DATISHA (BCBA)
Entity type:Individual
Prefix:MISS
First Name:DATISHA
Middle Name:
Last Name:YELDELL
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 1:7 PENDERGAST RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-6251
Mailing Address - Country:US
Mailing Address - Phone:803-293-6722
Mailing Address - Fax:
Practice Address - Street 1:7 PENDERGAST RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-6251
Practice Address - Country:US
Practice Address - Phone:803-293-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst