Healthcare Provider Details

I. General information

NPI: 1790326221
Provider Name (Legal Business Name): KRISTEN ANGELOU BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 AYRSLEY TOWN BLVD
CHARLOTTE NC
28273-3568
US

IV. Provider business mailing address

2132 AYRSLEY TOWN BLVD
CHARLOTTE NC
28273-3568
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax:
Mailing address:
  • Phone: 980-357-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3941
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: