MEDICARE: DIVINE STEPS ABA NC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1275484511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE STEPS ABA NC LLC

Provider Business Mailing Address
First Line	:	2 SHENANDOAH DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 N TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-0202
Country	:	US
Telephone Number	:	410-220-0768
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MINDY SPITZ
Credential	:
Telephone Number	:	410-220-0768

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/05/2026

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Directions to “DIVINE STEPS ABA NC LLC ” Practice Location

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