Healthcare Provider Details

I. General information

NPI: 1619593175
Provider Name (Legal Business Name): ABA ESSENTIALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 06/28/2020
Certification Date: 06/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 SCHOMBURG RD APT 601
COLUMBUS GA
31909-1516
US

IV. Provider business mailing address

6900 SCHOMBURG RD APT 601
COLUMBUS GA
31909-1516
US

V. Phone/Fax

Practice location:
  • Phone: 256-926-8246
  • Fax:
Mailing address:
  • Phone: 256-926-8246
  • 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 Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDALYN NEW
Title or Position: OWNER/CEO
Credential: BCBA
Phone: 256-926-8246