Provider Demographics
NPI:1518546308
Name:MABY, THOMAS GREGORY (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GREGORY
Last Name:MABY
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SILVERSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8734
Mailing Address - Country:US
Mailing Address - Phone:919-946-5581
Mailing Address - Fax:
Practice Address - Street 1:3500 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2947
Practice Address - Country:US
Practice Address - Phone:570-396-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-21-48843103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst