Healthcare Provider Details

I. General information

NPI: 1750988200
Provider Name (Legal Business Name): JOALIS M DE LA CRUZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOALIS MARIE DE LA CRUZ

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 GROVE LN
GOLDSBORO NC
27534-2002
US

IV. Provider business mailing address

216 GROVE LN
GOLDSBORO NC
27534-2002
US

V. Phone/Fax

Practice location:
  • Phone: 808-840-3838
  • Fax:
Mailing address:
  • Phone: 808-840-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3882
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: