MEDICARE: LUKE CARROLL DAIGLE

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	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst	3264	NC

General Provider Information

NPI Number	:	1578126462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE CARROLL DAIGLE

Provider Business Mailing Address
First Line	:	PO BOX 749
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-0749
Country	:	US
Telephone Number	:	704-869-2088
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 COPPERFIELD BLVD NE
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2404
Country	:	US
Telephone Number	:	704-706-2200
Fax Number	:	980-334-2110

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

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	01/13/2026

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Directions to “ LUKE CARROLL DAIGLE ” Practice Location

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