Basic Information
| Provider Information | |||||||||
| NPI: | 1477031623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPIVEY | ||||||||
| FirstName: | MADISON | ||||||||
| MiddleName: | JOYCE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MA, BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 CROWNPOINT EXECUTIVE DR STE E | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282276725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047088314 | ||||||||
| FaxNumber: | 7047088315 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 CROWNPOINT EXECUTIVE DR STE E | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282276725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047088314 | ||||||||
| FaxNumber: | 7047088315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2018 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-18-59462 | NC | N | 193400000X SINGLE SPECIALTY GROUP | 103K00000X | 1-20-44389 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.