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NPI Code Detail

MEDICARE: HEATHER BROOKS BCBA, LBA

MEDICARE: HEATHER BROOKS BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst3153NC

General Provider Information

NPI Number : 1669856548
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER BROOKS BCBA, LBA
Provider Business Mailing Address
First Line : 7809 SARDIS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28270-2757
Country : US
Telephone Number : 704-363-3777
Fax Number : 803-845-4977
Provider Business Practice Location Address
First Line : 7809 SARDIS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28270-2757
Country : US
Telephone Number : 980-313-5819
Fax Number : 803-548-3695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2015
Last Update Date : 10/01/2025

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