Provider Demographics
NPI:1710207477
Name:BALIS, VENESA ROSE (BCBA)
Entity type:Individual
Prefix:
First Name:VENESA
Middle Name:ROSE
Last Name:BALIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-0749
Mailing Address - Country:US
Mailing Address - Phone:704-869-2088
Mailing Address - Fax:980-288-4239
Practice Address - Street 1:823 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1510
Practice Address - Country:US
Practice Address - Phone:336-900-1555
Practice Address - Fax:336-332-2837
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1165103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst