Healthcare Provider Details

I. General information

NPI: 1063338705
Provider Name (Legal Business Name): SACHA JORDAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7903 PROVIDENCE RD
CHARLOTTE NC
28277-9720
US

IV. Provider business mailing address

7621 WATERFORD RIDGE DR APT 1116
CHARLOTTE NC
28212-7233
US

V. Phone/Fax

Practice location:
  • Phone: 855-800-9361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-545873
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: