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Behavioral Analyst

Concord, North Carolina

Provider NPI: 1558500942

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 704-788-8508  Fax: 704-403-2699

Business Mailing Address:
Tel: 704-788-8508  Fax: 704-403-2699

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number

Y103TS0200XBehavioral Health & Social Service Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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