Addison Black

Individual provider Active NPI Behavior Technician · Pineville, NC

NPI 1013568971 · NPPES record last updated Sep 23, 2019

Key facts

NPI
1013568971
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
License
RBT-19-99326 (NC)
Practice address
600 Towne Centre Blvd Ste 403
Pineville, NC 28134-8475
Phone
(980) 785-1113
Fax
(980) 785-1114
NPI assigned
Sep 23, 2019
Sex
Female
Sole proprietor
No

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
RBT-19-99326NCMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Mosaic Group, LLC Past
since Sep 29, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-19-99326 NC Yes

Addresses

Primary practice location

600 Towne Centre Blvd Ste 403
Pineville, NC 28134-8475

Mailing address

814 Tyvola Rd Ste 126
Charlotte, NC 28217-3539
Phone (980) 785-1113

Other providers in Pineville, NC

All providers in Pineville, NC · Behavior Technician in North Carolina

Sources for this page

Verify at the official NPI Registry.