Provider Demographics
NPI:1871922658
Name:CAPE FEAR ABA, P.C.
Entity type:Organization
Organization Name:CAPE FEAR ABA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGICAL ASSOCIATE
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPA, BCBA
Authorized Official - Phone:910-382-0009
Mailing Address - Street 1:202 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5010
Mailing Address - Country:US
Mailing Address - Phone:910-382-0009
Mailing Address - Fax:
Practice Address - Street 1:202 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5010
Practice Address - Country:US
Practice Address - Phone:910-382-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4389251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health