Healthcare Provider Details

I. General information

NPI: 1811771132
Provider Name (Legal Business Name): MICHELLE ANGEL PEREZ BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 HASTINGS LN
ELIZABETH CITY NC
27909-3324
US

IV. Provider business mailing address

111 SPENCE DR
ELIZABETH CITY NC
27909-8539
US

V. Phone/Fax

Practice location:
  • Phone: 252-662-1136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: