Provider Demographics
NPI:1508134958
Name:BIP-BEHAVIOR INTERVENTION PROFESSIONALS OF THE TRIANGLE, PLLC
Entity Type:Organization
Organization Name:BIP-BEHAVIOR INTERVENTION PROFESSIONALS OF THE TRIANGLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:919-818-3182
Mailing Address - Street 1:1009 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9858
Mailing Address - Country:US
Mailing Address - Phone:919-818-3182
Mailing Address - Fax:
Practice Address - Street 1:1009 POPLAR ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9858
Practice Address - Country:US
Practice Address - Phone:919-818-3182
Practice Address - Fax:919-384-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1696103K00000X, 103T00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty