Healthcare Provider Details

I. General information

NPI: 1700791753
Provider Name (Legal Business Name): KYLIE ERIN DOUGLAS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 WRIGHTSVILLE AVE
WILMINGTON NC
28403-6225
US

IV. Provider business mailing address

12363 BIG CANOE
BIG CANOE GA
30143-5165
US

V. Phone/Fax

Practice location:
  • Phone: 919-737-2292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90774
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: