Provider Demographics
NPI:1013745306
Name:GODLEY, ALYSSA (RBT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GODLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 LAKES ROCK DR UNIT 310
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3239
Mailing Address - Country:US
Mailing Address - Phone:252-531-6460
Mailing Address - Fax:
Practice Address - Street 1:8521 SIX FORKS RD STE 350
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5863
Practice Address - Country:US
Practice Address - Phone:919-676-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-24-6152-719588106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician