Healthcare Provider Details

I. General information

NPI: 1992360168
Provider Name (Legal Business Name): MICHELLE RENEE KLINE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE MICHAELS

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S WHITE ST STE 140
WAKE FOREST NC
27587-1405
US

IV. Provider business mailing address

535 S WHITE ST STE 140
WAKE FOREST NC
27587-1405
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax: 980-785-1114
Mailing address:
  • Phone: 908-785-1113
  • Fax: 980-785-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-33805
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: