Healthcare Provider Details

I. General information

NPI: 1952166399
Provider Name (Legal Business Name): OLIVIA BRIGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 AYRSLEY TOWN BLVD STE A
CHARLOTTE NC
28273-3542
US

IV. Provider business mailing address

1141 HOMESTEAD GLEN BLVD
CHARLOTTE NC
28214-8710
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2851404
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: