Healthcare Provider Details

I. General information

NPI: 1649134123
Provider Name (Legal Business Name): MARCELLA DIAMANTINO ANDRADE M.A., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8106 WHITEGROVE RD
MINT HILL NC
28227-1611
US

IV. Provider business mailing address

8106 WHITEGROVE RD
MINT HILL NC
28227-1611
US

V. Phone/Fax

Practice location:
  • Phone: 980-257-3852
  • Fax:
Mailing address:
  • Phone: 980-257-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3568
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: