Madison Evans – Behavior Technician

Key facts

NPI: 1053196196
Entity type: Individual (NPI type 1)
Primary specialty: Behavior Technician 106S00000X
License: RBT-23-293932 (NC)
Practice address: 3020 Henderson Dr
Jacksonville, NC 28546-5246
Phone: (910) 484-1711
NPI assigned: Aug 28, 2023
Sex: Female
Sole proprietor: Yes

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.

Autism Therapeutic Services Behavior Analyst · Fayetteville, NC · NPI 1598067449

NPD (past) BEHAVIOR TECHNICIAN

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-23-293932	NC	MD	Behavior Technician

Practice roles

Organization	Specialty	Status	New patients
Autism Therapeutic Services	Behavior Technician	Past since Sep 5, 2023	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Behavior Technician	106S00000X	RBT-23-293932	NC	Yes

Addresses

Primary practice location

3020 Henderson Dr
Jacksonville, NC 28546-5246

Mailing address

2919 Breezewood Ave Ste 101
Fayetteville, NC 28303-5283
Phone (910) 484-1711

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 28, 2023.

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1053196196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 BREEZEWOOD AVE STE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035283",
            "telephone_number": "910-484-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 HENDERSON DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465246",
            "telephone_number": "910-484-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "MADISON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NC",
            "license": "RBT-23-293932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

All providers in Jacksonville, 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 Aug 28, 2023. 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.

Verify at the official NPI Registry.