Healthcare Provider Details

I. General information

NPI: 1134553985
Provider Name (Legal Business Name): COMPASS BEHAVIORAL & DEVELOPMENTAL CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 N ASHLEY ST STE 112
VALDOSTA GA
31602-1788
US

IV. Provider business mailing address

2225 BEMISS RD SUITE D
VALDOSTA GA
31602-4818
US

V. Phone/Fax

Practice location:
  • Phone: 800-832-9419
  • Fax: 855-859-1671
Mailing address:
  • Phone: 800-832-9419
  • Fax: 855-859-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0051709
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0000083
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LYNDON PETER DELROSARIO
Title or Position: GENERAL PARTNER
Credential: BCABA
Phone: 18008329419