Healthcare Provider Details

I. General information

NPI: 1811769383
Provider Name (Legal Business Name): LIFE SKILLS ABA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 W SAND LAKE RD # SITE541
ORLANDO FL
32819-5248
US

IV. Provider business mailing address

8378 LUDINGTON CIR
ORLANDO FL
32836-5910
US

V. Phone/Fax

Practice location:
  • Phone: 305-202-3081
  • Fax:
Mailing address:
  • Phone: 305-202-3081
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DWAYNE NEBLETT
Title or Position: PRESIDENT
Credential:
Phone: 305-202-3081