Healthcare Provider Details

I. General information

NPI: 1588203657
Provider Name (Legal Business Name): STEPHANIE SPIRRISON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 NEW BIRCH DR STE 100
RALEIGH NC
27610-7000
US

IV. Provider business mailing address

1930 CAPITAL CREEK DR APT 5107
WAKE FOREST NC
27587-4061
US

V. Phone/Fax

Practice location:
  • Phone: 919-887-8853
  • Fax:
Mailing address:
  • Phone: 919-252-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4563
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: