Healthcare Provider Details

I. General information

NPI: 1073421400
Provider Name (Legal Business Name): VIBRANT ABA OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MANSELL RD STE 115
ROSWELL GA
30076-4877
US

IV. Provider business mailing address

675 MANSELL RD STE 115
ROSWELL GA
30076-4877
US

V. Phone/Fax

Practice location:
  • Phone: 877-888-8740
  • Fax:
Mailing address:
  • Phone: 877-888-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ARON GREENFELD
Title or Position: DIRECTOR
Credential:
Phone: 877-888-8740