MEDICARE: REBECCA ELMORE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-76646	NC

General Provider Information

NPI Number	:	1356018048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ELMORE BCBA

Provider Business Mailing Address
First Line	:	100 WILD SPRUCE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-8745
Country	:	US
Telephone Number	:	336-618-5473
Fax Number	:

Provider Business Practice Location Address
First Line	:	8311 BRIER CREEK PKWY STE 105-501
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-7328
Country	:	US
Telephone Number	:	336-560-7878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	11/13/2024

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