Provider Demographics
NPI:1114431830
Name:BLAKELY CABBIL, AMBER (BCBA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BLAKELY CABBIL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 HINSON FOREST RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-0038
Mailing Address - Country:US
Mailing Address - Phone:704-839-1488
Mailing Address - Fax:
Practice Address - Street 1:101 N TRYON ST STE 112
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28246-0104
Practice Address - Country:US
Practice Address - Phone:317-225-5352
Practice Address - Fax:855-975-2930
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2023-10-26
Deactivation Date:2021-09-07
Deactivation Code:
Reactivation Date:2021-09-23
Provider Licenses
StateLicense IDTaxonomies
NC1-19-40342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst