Shanavia Loujullia Alston

Individual provider Active NPI Behavior Technician · Charlotte, NC

NPI 1497364764 · NPPES record last updated Jul 23, 2020

Key facts

NPI
1497364764
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
1401 E 7TH St
Charlotte, NC 28204-6300
Phone
(704) 780-4271
Fax
(888) 261-6694
NPI assigned
Jul 23, 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 NC Yes

Addresses

Primary practice location

1401 E 7TH St
Charlotte, NC 28204-6300

Mailing address

8010 Woodscape Dr Apt C
Charlotte, NC 28212-0240
Phone (252) 820-9010

Other identifiers

IdentifierTypeStateIssuer
38175655OtherNCDRIVER'S LICENSE

Other providers in Charlotte, NC

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

Sources for this page

Verify at the official NPI Registry.