Healthcare Provider Details

I. General information

NPI: 1518623065
Provider Name (Legal Business Name): NOVA ABA & THERAPY SOLUTIONS LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 COMMUNITY SQUARE BLVD UNIT 1098
VILLA RICA GA
30180-5743
US

IV. Provider business mailing address

43 COMMUNITY SQUARE BLVD UNIT 1098
VILLA RICA GA
30180-5743
US

V. Phone/Fax

Practice location:
  • Phone: 469-400-1424
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA LEVESTON
Title or Position: OWNER/ CEO
Credential:
Phone: 770-858-8407