Healthcare Provider Details

I. General information

NPI: 1285394601
Provider Name (Legal Business Name): CANVAS ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14886 US HIGHWAY 17
HAMPSTEAD NC
28443-3217
US

IV. Provider business mailing address

770 HIGHLANDS DR
HAMPSTEAD NC
28443-7438
US

V. Phone/Fax

Practice location:
  • Phone: 910-746-7187
  • 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

VIII. Authorized Official

Name: KAYLA ZAMBRON
Title or Position: OWNER
Credential: M.A., BCBA, LBA
Phone: 910-746-7187