Basic Information
| Provider Information | |||||||||
| NPI: | 1497180384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEBB-GORDON | ||||||||
| FirstName: | JOCELYA | ||||||||
| MiddleName: | ANDREA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4930 LONG PIER LN UNIT 203 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276107721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9154934697 | ||||||||
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| Practice Location | |||||||||
| Address1: | 852 PERRY RD | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275027701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194465670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2013 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 103K00000X | 1-21-47612 | NC | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.