Healthcare Provider Details

I. General information

NPI: 1588365837
Provider Name (Legal Business Name): APPLIED BEHAVIOR ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BROADLEAF TRL
GROVETOWN GA
30813-4061
US

IV. Provider business mailing address

336 GEORGIA AVE STE 106
NORTH AUGUSTA SC
29841-3887
US

V. Phone/Fax

Practice location:
  • Phone: 706-945-2897
  • Fax:
Mailing address:
  • Phone: 706-450-2600
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLIE LAWRENCE
Title or Position: FOUNDER/CEO
Credential:
Phone: 706-945-2897