Healthcare Provider Details

I. General information

NPI: 1790698736
Provider Name (Legal Business Name): CHRISTA CHANELL FREEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 INDEPENDENCE BLVD STE 100
WILMINGTON NC
28412-0019
US

IV. Provider business mailing address

200 ASHCROFT DR
JACKSONVILLE NC
28546-6115
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 910-388-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-285136
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: