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General NPI Number Information
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NPI Number | 1457853541
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Entity Type | Individual
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Provider Name | RENE DELOACH BCABA
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Gender | Female
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 3540 TORINGDON WAY STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28277-4650
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Country | US
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Telephone | 980-374-4506
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 KEYDET DR
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City | CHARLOTTE
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State | NC
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Zip | 28216-5832
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Country | US
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Telephone |
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-23-14926
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License Number State | NC
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