Healthcare Provider Details

I. General information

NPI: 1811661366
Provider Name (Legal Business Name): MISS XANATHEA MARIA LAMONACA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 ENERGY DRIVE BUILDING #9
APEX NC
27502
US

IV. Provider business mailing address

1210 ALDERSGATE RD
LITTLE ROCK AR
72205-6606
US

V. Phone/Fax

Practice location:
  • Phone: 919-589-4523
  • Fax:
Mailing address:
  • Phone: 501-574-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50496
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: