Healthcare Provider Details

I. General information

NPI: 1750929774
Provider Name (Legal Business Name): EARLY ABA & ACADEMIC INTERVENTION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SAND LAKE RD STE 176
ORLANDO FL
32809-7747
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 TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

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