Healthcare Provider Details

I. General information

NPI: 1669021762
Provider Name (Legal Business Name): RAWAN NOUR MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 MORNING STAR LN
WINSTON SALEM NC
27107-6241
US

IV. Provider business mailing address

2140 MORNING STAR LN
WINSTON SALEM NC
27107-6241
US

V. Phone/Fax

Practice location:
  • Phone: 916-904-2732
  • Fax:
Mailing address:
  • Phone: 916-904-2732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76514
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: