Healthcare Provider Details

I. General information

NPI: 1801362868
Provider Name (Legal Business Name): MARY JANE B GALENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6985 NEXUS CT STE 107
FAYETTEVILLE NC
28304-3186
US

IV. Provider business mailing address

1213 GEESE CT
HOPE MILLS NC
28348-6016
US

V. Phone/Fax

Practice location:
  • Phone: 910-728-4999
  • Fax:
Mailing address:
  • Phone: 910-495-6177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: