Healthcare Provider Details

I. General information

NPI: 1982169140
Provider Name (Legal Business Name): MELISSA EDWARDS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 E WT HARRIS BLVD
CHARLOTTE NC
28213-5186
US

IV. Provider business mailing address

2329 E WT HARRIS BLVD
CHARLOTTE NC
28213-5186
US

V. Phone/Fax

Practice location:
  • Phone: 704-529-9090
  • Fax: 704-529-9009
Mailing address:
  • Phone: 704-529-9090
  • Fax: 704-529-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3853
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH002993
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: