Provider Demographics
NPI:1497021430
Name:CHARBONNEAU, MARGARET ANN (BCABA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:CHARBONNEAU
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 BRAWLEY SCHOOL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6876
Mailing Address - Country:US
Mailing Address - Phone:910-723-0255
Mailing Address - Fax:
Practice Address - Street 1:107 COMMERCE CENTRE DR STE 204
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5870
Practice Address - Country:US
Practice Address - Phone:910-723-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-12-4415103K00000X
NC4886103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst