Provider Demographics
NPI:1699061028
Name:BRANTLEY, AMBER (MA, LPA, BCBA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:MA, LPA, BCBA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:E
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPA, BCBA
Mailing Address - Street 1:PO BOX 10494
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404-0494
Mailing Address - Country:US
Mailing Address - Phone:919-630-8764
Mailing Address - Fax:
Practice Address - Street 1:7801 OLDE POND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-6206
Practice Address - Country:US
Practice Address - Phone:919-630-8764
Practice Address - Fax:910-401-1882
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-11-9046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst