Provider Demographics
NPI:1154736148
Name:AGRIS, MEGAN BROOKE (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BROOKE
Last Name:AGRIS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8413 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-9310
Mailing Address - Country:US
Mailing Address - Phone:919-219-6255
Mailing Address - Fax:
Practice Address - Street 1:4900 WATERS EDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-5662
Practice Address - Country:US
Practice Address - Phone:919-219-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11415180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst