Healthcare Provider Details

I. General information

NPI: 1831897255
Provider Name (Legal Business Name): DANIELLE HEPBOURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HENDERSON DR
JACKSONVILLE NC
28546-5246
US

IV. Provider business mailing address

2919 BREEZEWOOD AVE STE 101
FAYETTEVILLE NC
28303-5283
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-1711
  • Fax:
Mailing address:
  • Phone: 910-484-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: