Healthcare Provider Details

I. General information

NPI: 1225656317
Provider Name (Legal Business Name): MADELINE GUERIN DRIVES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NEW FIDELITY CT
GARNER NC
27529-2898
US

IV. Provider business mailing address

350 FAIRWAY DR STE 101
DEERFIELD BEACH FL
33441-1834
US

V. Phone/Fax

Practice location:
  • Phone: 704-572-3810
  • Fax:
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: