Full Spectrum ABA of North Carolina LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

FULL SPECTRUM ABA OF NORTH CAROLINA LLC

Practice address

4030 Wake Forest Rd Ste 349
Raleigh, NC 27609-0010

Phone

(813) 926-5454

NPI assigned

Nov 5, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Collin Edward Streetman, BCBA

Title

Owner

Phone

(813) 926-5454

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574208000000",
    "number": "1053955856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 WAKE FOREST RD STE 349",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276090010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4030 WAKE FOREST RD STE 349",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276090010",
            "telephone_number": "813-926-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SPECTRUM ABA OF NORTH CAROLINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-05",
        "last_updated": "2019-11-20",
        "status": "A",
        "authorized_official_last_name": "STREETMAN",
        "authorized_official_first_name": "COLLIN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-926-5454",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Alysha Fuller, PT, DPT
• Christi Fuller, LCMHCA

• Behavior Analyst in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Behavior Analyst in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.