Healthcare Provider Details

I. General information

NPI: 1306621743
Provider Name (Legal Business Name): ABA ENDEAVOR NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 W SUGAR CREEK RD STE 202
CHARLOTTE NC
28213-6102
US

IV. Provider business mailing address

7257 N LINCOLN AVE
LINCOLNWOOD IL
60712-1810
US

V. Phone/Fax

Practice location:
  • Phone: 704-385-7272
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JUDAH KANOWITZ
Title or Position: MANAGING PARTNER
Credential:
Phone: 917-275-5134