Healthcare Provider Details

I. General information

NPI: 1518469220
Provider Name (Legal Business Name): ZOE CENTER FOR ABA AND DEVELOPMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 13TH STREET SUITE D
COLUMBUS GA
31901
US

IV. Provider business mailing address

1110 13TH STREET SUITE D
COLUMBUS GA
31901
US

V. Phone/Fax

Practice location:
  • Phone: 888-963-2228
  • Fax: 706-780-1705
Mailing address:
  • Phone: 888-963-2228
  • Fax: 706-780-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number39388
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY LYNN SMITH-KONG
Title or Position: CEO
Credential: BCBA
Phone: 888-963-2228