Healthcare Provider Details

I. General information

NPI: 1255162434
Provider Name (Legal Business Name): FOUNDATIONS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GWYNNS MILL CT STE I
OWINGS MILLS MD
21117-3528
US

IV. Provider business mailing address

2405 STEELE RD
BALTIMORE MD
21209-3924
US

V. Phone/Fax

Practice location:
  • Phone: 404-502-6868
  • Fax:
Mailing address:
  • Phone: 202-706-5646
  • 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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH WISE
Title or Position: OWNER
Credential:
Phone: 404-502-6868