Healthcare Provider Details

I. General information

NPI: 1356265904
Provider Name (Legal Business Name): BRIDGET TREANOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 TRUST DR STE 3645
RALEIGH NC
27616-2955
US

IV. Provider business mailing address

814 TYVOLA RD STE 126
CHARLOTTE NC
28217-3539
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax: 980-785-1114
Mailing address:
  • Phone: 980-785-1113
  • Fax: 980-785-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2850923
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: