Healthcare Provider Details

I. General information

NPI: 1891375879
Provider Name (Legal Business Name): MICAH GARVIN BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 BOOTHE CIR
LONGWOOD FL
32750-6774
US

IV. Provider business mailing address

1900 PEAK CIR
APOPKA FL
32703-8580
US

V. Phone/Fax

Practice location:
  • Phone: 407-434-1556
  • Fax:
Mailing address:
  • Phone: 407-690-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15697
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: