Healthcare Provider Details

I. General information

NPI: 1760943674
Provider Name (Legal Business Name): SOUMYA MAPPILAKUNNEL PIOUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N HAYNE ST STE 100
MONROE NC
28112-4883
US

IV. Provider business mailing address

PO BOX 749
BELMONT NC
28012-0749
US

V. Phone/Fax

Practice location:
  • Phone: 980-313-4901
  • Fax: 980-315-4337
Mailing address:
  • Phone: 704-869-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number178
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52378
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1-19-78920
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: