Active NPI
Gabriella Fulwood
- Behavior Analyst
- Concord, NC
National Provider Identifier
1003568239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 2391
- Practice address
- 990 Lee Ann Dr NE Ste 2
Concord, NC 28025-2957 - Phone
- (704) 799-6824
- Fax
- (704) 799-6825
- NPI assigned
- Jan 19, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 2391 | NC | Primary |
Addresses
Primary practice location
990 Lee Ann Dr NE Ste 2
Concord, NC 28025-2957
Mailing address
134 Infield CT
Mooresville, NC 28117-8026
Phone (704) 799-6824
Other practice location 1
134 Infield Ct
Mooresville, NC 28117-8026
Phone (704) 799-6824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2391 | NC | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrative Therapy Concepts | Past | Accepting new patients | |
| Lolly Therapeutics, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Occupational Therapist
- Mooresville, NC
- NPI 1508849332
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736121600000",
"number": "1003568239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 INFIELD CT",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281178026",
"telephone_number": "704-799-6824",
"fax_number": "704-799-6825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "990 LEE ANN DR NE STE 2",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252957",
"telephone_number": "704-799-6824",
"fax_number": "704-799-6825"
}
],
"practiceLocations": [
{
"address_1": "134 Infield Ct",
"address_purpose": "LOCATION",
"city": "Mooresville",
"state": "NC",
"postal_code": "281178026",
"country_code": "US",
"telephone_number": "704-799-6824",
"fax_number": "704-799-6825",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FULWOOD",
"first_name": "GABRIELLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-19",
"last_updated": "2025-01-06",
"certification_date": "2025-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NC",
"license": "2391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.