Healthcare Provider Details

I. General information

NPI: 1992214019
Provider Name (Legal Business Name): ANGELA JONES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25124 NARBONNE AVE STE 102
LOMITA CA
90717-2140
US

IV. Provider business mailing address

920 CAMBRIDGE ST
FAYETTEVILLE NC
28303-5300
US

V. Phone/Fax

Practice location:
  • Phone: 888-286-8715
  • Fax: 888-286-8715
Mailing address:
  • Phone: 910-493-3555
  • Fax: 910-493-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12040547
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: