1104551118 NPI number — COURTNEY BURLEIGH RBT

Table of content: COURTNEY BURLEIGH RBT (NPI 1104551118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104551118 NPI number — COURTNEY BURLEIGH RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURLEIGH
Provider First Name:
COURTNEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104551118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3126 W CARY ST
Provider Second Line Business Mailing Address:
ATLANTIC AUTISM SERVICES, INC, BOX #116
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-677-5100
Provider Business Mailing Address Fax Number:
252-677-5110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431B WEEKSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-8431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-677-5100
Provider Business Practice Location Address Fax Number:
252-677-5110
Provider Enumeration Date:
07/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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