Healthcare Provider Details

I. General information

NPI: 1275437600
Provider Name (Legal Business Name): COLE FORNESS MA, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 STELFOX ST, SUITE 101
CHARLOTTE NC
28262
US

IV. Provider business mailing address

9827 WITHERS RD
CHARLOTTE NC
28278-6821
US

V. Phone/Fax

Practice location:
  • Phone: 919-745-8892
  • Fax:
Mailing address:
  • Phone: 704-839-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: