Healthcare Provider Details

I. General information

NPI: 1457095747
Provider Name (Legal Business Name): YOUR WAY ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2022
Last Update Date: 04/23/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732A MARSH RD SUITE 101
WILMINGTON DE
19810
US

IV. Provider business mailing address

8625 ASPEN CT
CHARLOTTE NC
28227-7074
US

V. Phone/Fax

Practice location:
  • Phone: 402-401-4389
  • Fax: 877-810-2137
Mailing address:
  • Phone: 848-444-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE EUGENIO
Title or Position: OWNER
Credential:
Phone: 732-995-8432