Healthcare Provider Details

I. General information

NPI: 1023792314
Provider Name (Legal Business Name): TRANSFORMATION THERAPY SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705A WESLEY PINES RD
LUMBERTON NC
28358-2105
US

IV. Provider business mailing address

705A WESLEY PINES RD
LUMBERTON NC
28358-2105
US

V. Phone/Fax

Practice location:
  • Phone: 910-733-1130
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: AARIANEILIA JANINE LOCKLEAR
Title or Position: OWNER
Credential: QASP-S
Phone: 910-370-0721