Healthcare Provider Details

I. General information

NPI: 1982472791
Provider Name (Legal Business Name): TOUCHED BY AN ANGEL ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 W COLONIAL DR STE A
ORLANDO FL
32804-7118
US

IV. Provider business mailing address

1843 PAGE LEIGH CIR APT 1621
APOPKA FL
32703-3480
US

V. Phone/Fax

Practice location:
  • Phone: 407-272-7823
  • Fax:
Mailing address:
  • Phone: 407-272-7823
  • 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
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWANZA LATRISA DILLARD
Title or Position: FOUNDER / OWNER
Credential: BEHAVIOR TECHNICIAN
Phone: 407-272-7823