Healthcare Provider Details

I. General information

NPI: 1992500136
Provider Name (Legal Business Name): A DIFFERENT DIMENSIONS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 AYRSLEY TOWN BLVD STE 202
CHARLOTTE NC
28273-4068
US

IV. Provider business mailing address

135 ROCKAWAY TPKE STE 101
LAWRENCE NY
11559-1033
US

V. Phone/Fax

Practice location:
  • Phone: 201-566-3947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ANDREW TEIGMAN
Title or Position: MANAGING PARTNER
Credential:
Phone: 201-566-3947