Latara Shari Branch

Individual provider Active NPI Behavior Technician · Raeford, NC

NPI 1164050720 · NPPES record last updated Mar 30, 2020

Key facts

NPI
1164050720
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
6223 Turnpike Rd
Raeford, NC 28376-7306
Phone
(910) 747-0337
NPI assigned
Mar 30, 2020
Sex
Female
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Behavior Technician
Group: 193200000X MULTI-SPECIALTY GROUP
106S00000X NC Yes

Addresses

Primary practice location

6223 Turnpike Rd
Raeford, NC 28376-7306

Mailing address

111 Mackenan Dr
Cary, NC 27511-7903
Phone (910) 747-0337

Other providers in Raeford, NC

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

Sources for this page

Verify at the official NPI Registry.