Healthcare Provider Details

I. General information

NPI: 1770132276
Provider Name (Legal Business Name): INFLUENCE BEHAVIOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9483 MUIRKIRK RD
LAUREL MD
20708-2764
US

IV. Provider business mailing address

252 BAL GRA RD
MERRY HILL NC
27957-9744
US

V. Phone/Fax

Practice location:
  • Phone: 252-331-3485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JENAE HOLLEY
Title or Position: CFO
Credential:
Phone: 252-331-3485