Healthcare Provider Details

I. General information

NPI: 1891298378
Provider Name (Legal Business Name): STEPHANIE YOUNG BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431B WEEKSVILLE RD
ELIZABETH CITY NC
27909-8431
US

IV. Provider business mailing address

1431B WEEKSVILLE RD
ELIZABETH CITY NC
27909-8431
US

V. Phone/Fax

Practice location:
  • Phone: 252-677-5100
  • Fax: 252-677-5110
Mailing address:
  • Phone: 252-677-5100
  • Fax: 252-677-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45030
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1744691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: