Healthcare Provider Details

I. General information

NPI: 1053243923
Provider Name (Legal Business Name): AMY JULISSA MORALES RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 MATTHEWS TOWNSHIP PKWY
MATTHEWS NC
28105-5927
US

IV. Provider business mailing address

2301 CROWNPOINT EXECUTIVE DR STE E
CHARLOTTE NC
28227-6725
US

V. Phone/Fax

Practice location:
  • Phone: 704-842-3417
  • Fax:
Mailing address:
  • Phone: 980-202-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-512480
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: