Healthcare Provider Details

I. General information

NPI: 1376124743
Provider Name (Legal Business Name): ALLIANCE ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 SHADY OAK LN
DELAND FL
32720-2546
US

IV. Provider business mailing address

1145 SHADY OAK LN
DELAND FL
32720-2546
US

V. Phone/Fax

Practice location:
  • Phone: 386-837-5627
  • Fax:
Mailing address:
  • Phone:
  • 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: SHONNIE BENNETT-PERRY
Title or Position: OWNER
Credential: BCBA-D
Phone: 386-837-5627