Provider Demographics
NPI:1184507543
Name:ALMODOVAR, TINA L (RBT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:ALMODOVAR
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BELMONT TRL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9672
Mailing Address - Country:US
Mailing Address - Phone:860-455-6190
Mailing Address - Fax:
Practice Address - Street 1:447 VENTURE DR STE D
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4765
Practice Address - Country:US
Practice Address - Phone:919-457-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-25-426739106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty