Healthcare Provider Details

I. General information

NPI: 1659953164
Provider Name (Legal Business Name): INSPIRE ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 OAKHURST DR
EVANS GA
30809-3712
US

IV. Provider business mailing address

5549 CONNOR DR
EVANS GA
30809-6164
US

V. Phone/Fax

Practice location:
  • Phone: 706-572-6031
  • Fax: 762-224-0104
Mailing address:
  • Phone: 706-572-6031
  • Fax: 762-224-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICIA A YOSHIMOTO
Title or Position: BCBA/OWNER
Credential: MA, BCBA
Phone: 706-572-6031