Healthcare Provider Details

I. General information

NPI: 1619890316
Provider Name (Legal Business Name): ZACHARY ROSS WHITLEY RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 JOHN PLATT DR
MOREHEAD CITY NC
28557-4372
US

IV. Provider business mailing address

405 DEBBIE ST
BAYBORO NC
28515-9443
US

V. Phone/Fax

Practice location:
  • Phone: 252-777-3140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2834667
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: