Individual
MADELINE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7022 SARDIS RD, CHARLOTTE, NC 28270-6058
(704) 366-8260
Mailing address
7022 SARDIS RD, CHARLOTTE, NC 28270-6058
(704) 366-8260
(704) 366-8210
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
17-44849
AL
106E00000X
Assistant Behavior Analyst
RBT-17-44849
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316453400
BCBA
NC
Enumeration date
12/27/2017
Last updated
05/25/2021
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