Healthcare Provider Details

I. General information

NPI: 1306768619
Provider Name (Legal Business Name): KATIE HERNANDEZ CHAVEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BAXTER ST SUITE 450 AND 455
CHARLOTTE NC
28204
US

IV. Provider business mailing address

709 SPARROW SPRINGS RD
KINGS MOUNTAIN NC
28086-8647
US

V. Phone/Fax

Practice location:
  • Phone: 704-336-1075
  • Fax:
Mailing address:
  • Phone: 404-747-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: