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General NPI Number Information
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NPI Number | 1386327518
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Entity Type | Individual
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Provider Name | MISS ALEXIS B LAU
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 1368 PINEY GREEN RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-4580
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Country | US
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Telephone | 910-333-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 301 VILLAGE DR APT 12D
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7748
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Country | US
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Telephone | 605-650-8698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-290766
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License Number State | NC
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