Healthcare Provider Details

I. General information

NPI: 1487343232
Provider Name (Legal Business Name): KSD ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 PEACHTREE RD NE
ATLANTA GA
30326-3254
US

IV. Provider business mailing address

3455 PEACHTREE RD NE
ATLANTA GA
30326-3254
US

V. Phone/Fax

Practice location:
  • Phone: 929-466-1305
  • 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: SIM B
Title or Position: DIRECTOR
Credential:
Phone: 929-466-1305