Healthcare Provider Details

I. General information

NPI: 1992384358
Provider Name (Legal Business Name): POSITIVE SUPPORT BEHAVIOR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N TRYON ST STE 1600
CHARLOTTE NC
28202-0213
US

IV. Provider business mailing address

288 IROQUOIS TRL
LEXINGTON NC
27295-8214
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MARISA DOSS
Title or Position: REGISTER BEHAVIOR TECHNICIAN
Credential:
Phone: 704-728-5810