Provider Demographics
NPI:1245531409
Name:KOLB, RACHEL NOELLE (BCBA, MA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NOELLE
Last Name:KOLB
Suffix:
Gender:F
Credentials:BCBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-7622
Mailing Address - Country:US
Mailing Address - Phone:910-915-5273
Mailing Address - Fax:910-333-1799
Practice Address - Street 1:209 E RIDGE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-7622
Practice Address - Country:US
Practice Address - Phone:910-915-5273
Practice Address - Fax:910-333-1799
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-10-7733103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst