Healthcare Provider Details

I. General information

NPI: 1023528072
Provider Name (Legal Business Name): BRENDA JANELLE MCCANTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MACKENAN DR
CARY NC
27511
US

IV. Provider business mailing address

111 MACKENAN DR
CARY NC
27511-7903
US

V. Phone/Fax

Practice location:
  • Phone: 919-371-2848
  • Fax: 919-467-6777
Mailing address:
  • Phone: 919-371-2848
  • Fax: 919-467-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30913
License Number StateNC

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: