Provider Demographics
NPI:1619678885
Name:PAGE, JUDY WALKER (RBT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:WALKER
Last Name:PAGE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:CHARLEEN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 MILITARY CUTOFF RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-9737
Mailing Address - Country:US
Mailing Address - Phone:910-392-0080
Mailing Address - Fax:910-392-7035
Practice Address - Street 1:500 MILITARY CUTOFF RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-9737
Practice Address - Country:US
Practice Address - Phone:910-392-0080
Practice Address - Fax:910-392-7035
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-23-260848106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician