Provider Demographics
NPI:1215380142
Name:DOUGLAS, BRITTANY MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MARIE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:MARIE
Other - Last Name:BUCHWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:716 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1851
Mailing Address - Country:US
Mailing Address - Phone:704-522-9912
Mailing Address - Fax:704-566-6050
Practice Address - Street 1:716 MARSH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1851
Practice Address - Country:US
Practice Address - Phone:704-522-9912
Practice Address - Fax:704-566-6050
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-19-35101103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34083612Medicaid