Provider Demographics
NPI:1649877382
Name:BOZEMAN, MICHELLE (RBT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BOZEMAN
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 1:1915 BRAXTON CT APT 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-1201
Mailing Address - Country:US
Mailing Address - Phone:910-262-8714
Mailing Address - Fax:
Practice Address - Street 1:5101 DUNLEA CT STE 201C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4436
Practice Address - Country:US
Practice Address - Phone:910-899-6064
Practice Address - Fax:910-390-6627
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health