Provider Demographics
NPI:1306543350
Name:JACKSON-MCBRIDE, MARIA AURIEL (BS,MS,RBT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:AURIEL
Last Name:JACKSON-MCBRIDE
Suffix:
Gender:F
Credentials:BS,MS,RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CLUB CONNECTION BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-9599
Mailing Address - Country:US
Mailing Address - Phone:678-900-6290
Mailing Address - Fax:
Practice Address - Street 1:600 NEW WAVERLY PL STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7404
Practice Address - Country:US
Practice Address - Phone:919-594-1649
Practice Address - Fax:919-917-7148
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician