Healthcare Provider Details

I. General information

NPI: 1720631021
Provider Name (Legal Business Name): ABIGAIL CROY SANTOS LBA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL CROY RBT

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4778 OVERTON RD
BIRMINGHAM AL
35210-3803
US

IV. Provider business mailing address

4778 OVERTON RD
BIRMINGHAM AL
35210-3803
US

V. Phone/Fax

Practice location:
  • Phone: 205-957-0294
  • Fax: 205-957-0298
Mailing address:
  • Phone: 205-957-0294
  • Fax: 205-957-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2021-073
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: