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
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-99326 | NC | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mosaic Group, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
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- Janice S Blocker
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- Brian Wayne Bowman
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All providers in Pineville, NC · Behavior Technician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.