Healthcare Provider Details

I. General information

NPI: 1780415547
Provider Name (Legal Business Name): SEEDGROW ABA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8269 LANTERN LN
COLUMBUS GA
31904-1560
US

IV. Provider business mailing address

8269 LANTERN LN
COLUMBUS GA
31904-1560
US

V. Phone/Fax

Practice location:
  • Phone: 706-304-1287
  • Fax:
Mailing address:
  • Phone: 706-304-1287
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE NICOLE KNOX
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: BCBA-D
Phone: 706-304-1287