Healthcare Provider Details

I. General information

NPI: 1083543896
Provider Name (Legal Business Name): JUSTIN CALLEMYN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 TALS ROCK WAY STE 3
CARY NC
27519-1919
US

IV. Provider business mailing address

210 TALS ROCK WAY STE 3
CARY NC
27519-1919
US

V. Phone/Fax

Practice location:
  • Phone: 919-745-8892
  • Fax: 919-887-7057
Mailing address:
  • Phone: 919-745-8892
  • Fax: 919-887-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89499
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: