Provider Demographics
NPI:1144556523
Name:ABC APPLIED INTERVENTIONS AND SUPPORTS
Entity type:Organization
Organization Name:ABC APPLIED INTERVENTIONS AND SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISIA
Authorized Official - Middle Name:BAUKNIGHT
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-960-0229
Mailing Address - Street 1:553 CHISOLM WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-8076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:553 CHISOLM WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8076
Practice Address - Country:US
Practice Address - Phone:803-960-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX8288Medicaid