Healthcare Provider Details

I. General information

NPI: 1639826027
Provider Name (Legal Business Name): RACHEL VAN METRE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 VIRGINIA AVE
WILMINGTON NC
28401-7000
US

IV. Provider business mailing address

240 AMBERLEIGH DR APT 204
WILMINGTON NC
28411-8018
US

V. Phone/Fax

Practice location:
  • Phone: 47-591-9375
  • Fax:
Mailing address:
  • Phone: 336-669-0810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12263249
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-196222
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: