Healthcare Provider Details

I. General information

NPI: 1780456046
Provider Name (Legal Business Name): MINDCRAFT ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 03/10/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 TILLMAN ST
MONROE NC
28112
US

IV. Provider business mailing address

8300 WAXHAW HWY
WAXHAW NC
28173-2016
US

V. Phone/Fax

Practice location:
  • Phone: 305-384-0610
  • Fax:
Mailing address:
  • Phone: 305-384-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAVIER HERRERA
Title or Position: OWNER
Credential: BCBA
Phone: 305-384-0610