Healthcare Provider Details

I. General information

NPI: 1003621012
Provider Name (Legal Business Name): BALANCE ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 HARBOR BAY DR
LAWRENCEVILLE GA
30045-3413
US

IV. Provider business mailing address

820 HARBOR BAY DR
LAWRENCEVILLE GA
30045-3413
US

V. Phone/Fax

Practice location:
  • Phone: 323-867-4323
  • Fax:
Mailing address:
  • Phone: 323-867-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DIANA CAROLINA ECHEVERRIA
Title or Position: OWNER
Credential:
Phone: 470-924-2211