Provider Demographics
NPI:1528583903
Name:DRIER, CARMEN M (BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:M
Last Name:DRIER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:M
Other - Last Name:WIXSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:200 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7986
Mailing Address - Country:US
Mailing Address - Phone:910-973-0690
Mailing Address - Fax:
Practice Address - Street 1:39420 LIBERTY ST STE 150
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2284
Practice Address - Country:US
Practice Address - Phone:510-794-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NC1-19-36958103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1-19-36958OtherBEHAVIOR ANALYST CERTIFICATION BOARD, BACB