MEDICARE: ALL ABOARD ABA, 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	:	1588336184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL ABOARD ABA, LLC

Provider Business Mailing Address
First Line	:	1820 CASTLETON CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5765
Country	:	US
Telephone Number	:	757-778-3895
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 CASTLETON CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5765
Country	:	US
Telephone Number	:	757-778-3895
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TERI GEORGE
Credential	:	MA, BCBA, LBA
Telephone Number	:	757-778-3895

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	10/01/2021

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