Healthcare Provider Details

I. General information

NPI: 1861172330
Provider Name (Legal Business Name): JACOB ROBERTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BRANCHVIEW DR NE STE 215
CONCORD NC
28025-2239
US

IV. Provider business mailing address

1040 COPPERFIELD BLVD NE
CONCORD NC
28025-2451
US

V. Phone/Fax

Practice location:
  • Phone: 704-780-4271
  • Fax: 888-261-6649
Mailing address:
  • Phone: 704-780-4271
  • Fax: 888-261-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: