Healthcare Provider Details

I. General information

NPI: 1992495295
Provider Name (Legal Business Name): HEARTLINKS ABA NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N TRYON ST STE 1600
CHARLOTTE NC
28202-0213
US

IV. Provider business mailing address

1970 SWARTHMORE AVE STE 4
LAKEWOOD NJ
08701-4553
US

V. Phone/Fax

Practice location:
  • Phone: 888-755-4657
  • Fax: 732-612-1166
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
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AVRAHAM JURKANSKI
Title or Position: DIRECTOR
Credential:
Phone: 888-755-4657