Healthcare Provider Details

I. General information

NPI: 1659286599
Provider Name (Legal Business Name): ALISHA NICOLE BAINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 CAPITAL BLVD STE 123
YOUNGSVILLE NC
27596-7854
US

IV. Provider business mailing address

2214 ARBOR RD N
WILSON NC
27893-1706
US

V. Phone/Fax

Practice location:
  • Phone: 252-886-3864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-529706
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: