Healthcare Provider Details

I. General information

NPI: 1659981298
Provider Name (Legal Business Name): LIZ VALENTINA SEPULVEDA GOMEZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N BROOME ST
WAXHAW NC
28173-9378
US

IV. Provider business mailing address

1440 HARDING PL APT 661
CHARLOTTE NC
28204-0030
US

V. Phone/Fax

Practice location:
  • Phone: 980-529-7930
  • Fax:
Mailing address:
  • Phone: 619-665-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2836553
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: