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16325 Northcross Dr Ste A Huntersville NC 28078-5044 | |
| (704) 773-8115 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 16325 Northcross Dr Ste A, Huntersville, North Carolina |
| Authorized Official Name and Position | Tanisha Dacosta (CEO) |
| Authorized Official Contact | 7047738115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16325 Northcross Dr Ste A Huntersville NC 28078-5044 Ph: (704) 773-8115 | 16325 Northcross Dr Ste A Huntersville NC 28078-5044 Ph: (704) 773-8115 |
| NPI Number | 1235940321 |
|---|---|
| Provider Enumeration Date | 01/16/2025 |
| Last Update Date | 01/29/2025 |
| Certification Date | 01/29/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235940321 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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