Provider Demographics
NPI:1205113511
Name:JACOME, NATALIE BROOKE (MA, LPA, BCBA)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:BROOKE
Last Name:JACOME
Suffix:
Gender:F
Credentials:MA, LPA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1715
Mailing Address - Country:US
Mailing Address - Phone:919-801-8805
Mailing Address - Fax:
Practice Address - Street 1:647 BRAWLEY SCHOOL RD STE 104
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6876
Practice Address - Country:US
Practice Address - Phone:704-703-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103K00000X
NC3564103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities