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General NPI Number Information
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NPI Number | 1609538933
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Entity Type | Individual
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Provider Name | CARLYE NICOLE GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 304 WELLINGTON PL
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City | JACKSONVILLE
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State | NC
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Zip | 28546-8341
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Country | US
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Telephone | 910-939-9986
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Fax | 910-939-1697
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Provider Business Mailing Address
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Address Line | 7235 BESTWICK AVE
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-4504
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Country | US
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Telephone | 901-930-5300
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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 |
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License Number State | NC
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