Provider Demographics
NPI:1043623655
Name:PATTERSON, BETHANY (BCBA-D)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:COLACCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:130 SUMMERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-2717
Mailing Address - Country:US
Mailing Address - Phone:252-510-1134
Mailing Address - Fax:
Practice Address - Street 1:130 SUMMERFIELD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-2717
Practice Address - Country:US
Practice Address - Phone:252-510-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000896103K00000X
HI0-15-6846103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst