Healthcare Provider Details

I. General information

NPI: 1831907666
Provider Name (Legal Business Name): ALEXIS JACKSON MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 STATE AVE STE 100
CLAYTON NC
27520-7546
US

IV. Provider business mailing address

135 STATE AVE STE 100
CLAYTON NC
27520-7546
US

V. Phone/Fax

Practice location:
  • Phone: 984-316-4550
  • Fax:
Mailing address:
  • Phone: 984-316-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3830
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: