Healthcare Provider Details

I. General information

NPI: 1457853541
Provider Name (Legal Business Name): RENE DELOACH BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 TORINGDON WAY STE 200
CHARLOTTE NC
28277-4650
US

IV. Provider business mailing address

1112 KEYDET DR
CHARLOTTE NC
28216-5832
US

V. Phone/Fax

Practice location:
  • Phone: 980-374-4506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14926
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: