Provider Demographics
NPI:1033000765
Name:EISTERHOLD, GRACE MARIA (BCBA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIA
Last Name:EISTERHOLD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 ALMA GROVE LN APT 3511
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4448
Mailing Address - Country:US
Mailing Address - Phone:573-821-4607
Mailing Address - Fax:
Practice Address - Street 1:2102 CAMBRIDGE BELTWAY DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4354
Practice Address - Country:US
Practice Address - Phone:704-799-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst