Healthcare Provider Details

I. General information

NPI: 1407782873
Provider Name (Legal Business Name): ALEXANDRA WONG RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1000 PARK FORTY PLZ STE 110
DURHAM NC
27713-5249
US

IV. Provider business mailing address

1011 CLARENDON ST APT A
DURHAM NC
27705-4211
US

V. Phone/Fax

Practice location:
  • Phone: 919-480-2800
  • Fax:
Mailing address:
  • Phone: 301-814-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-545275
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: