Healthcare Provider Details

I. General information

NPI: 1447931217
Provider Name (Legal Business Name): JILLIAN PATRIA BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6634 OLD STATESVILLE RD
CHARLOTTE NC
28269-6768
US

IV. Provider business mailing address

300 KILMER LN
MOORESVILLE NC
28115-9081
US

V. Phone/Fax

Practice location:
  • Phone: 704-251-4898
  • Fax:
Mailing address:
  • Phone: 603-933-1452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: