Healthcare Provider Details

I. General information

NPI: 1144888777
Provider Name (Legal Business Name): MRS. SABRINA RACHELLE IRELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WINDSOR PATH STE 2
GEORGETOWN KY
40324-9610
US

IV. Provider business mailing address

103 WINDSOR PATH STE 2
GEORGETOWN KY
40324-9610
US

V. Phone/Fax

Practice location:
  • Phone: 859-757-1022
  • Fax: 901-545-5189
Mailing address:
  • Phone: 859-757-1022
  • Fax: 901-545-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89734
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-59994
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: