Healthcare Provider Details

I. General information

NPI: 1003469339
Provider Name (Legal Business Name): POSITIVE DIFFERENCES ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PEACHTREE ST NE STE 200
ATLANTA GA
30309-4829
US

IV. Provider business mailing address

1100 PEACHTREE ST NE STE 200
ATLANTA GA
30309-4829
US

V. Phone/Fax

Practice location:
  • Phone: 404-721-1888
  • Fax:
Mailing address:
  • Phone: 404-721-1888
  • 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 Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMY EBOZUE
Title or Position: OWNER, LEAD CLINICAN
Credential: BCBA
Phone: 404-721-1888