Provider Demographics
NPI:1285410035
Name:TABORN, ALYCIA FRANCESCA (BA)
Entity type:Individual
Prefix:MRS
First Name:ALYCIA
Middle Name:FRANCESCA
Last Name:TABORN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ALYCIA
Other - Middle Name:FRANCESCA
Other - Last Name:CAROTENUTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALYCIA CAROTENUTI
Mailing Address - Street 1:3651 CRITTER TRL
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-5860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3651 CRITTER TRL
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-5860
Practice Address - Country:US
Practice Address - Phone:252-341-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13825106S00000X
NC04200866325171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician