Healthcare Provider Details

I. General information

NPI: 1770198905
Provider Name (Legal Business Name): NORTH FLORIDA BEHAVIOR CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 PALISADE DR
ST AUGUSTINE FL
32092-1139
US

IV. Provider business mailing address

87 PALISADE DR
ST AUGUSTINE FL
32092-1139
US

V. Phone/Fax

Practice location:
  • Phone: 704-965-4276
  • 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

VIII. Authorized Official

Name: ARTHUR HAIRSTON
Title or Position: OWNER
Credential: BCBA
Phone: 704-965-4276