Provider Demographics
NPI:1639704547
Name:DECANDIA, ANTHONY J (RBT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:DECANDIA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4634 HARMONY LN
Mailing Address - Street 2:
Mailing Address - City:EFLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27243-9456
Mailing Address - Country:US
Mailing Address - Phone:919-742-0919
Mailing Address - Fax:
Practice Address - Street 1:4634 HARMONY LN
Practice Address - Street 2:
Practice Address - City:EFLAND
Practice Address - State:NC
Practice Address - Zip Code:27243-9456
Practice Address - Country:US
Practice Address - Phone:919-742-0919
Practice Address - Fax:919-304-1100
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17-34380103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty