Healthcare Provider Details

I. General information

NPI: 1508785775
Provider Name (Legal Business Name): WILDFLOWER ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CAMARO RIFT TRL
WENDELL NC
27591-4439
US

IV. Provider business mailing address

540 CAMARO RIFT TRL
WENDELL NC
27591-4439
US

V. Phone/Fax

Practice location:
  • Phone: 703-862-1690
  • 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

VIII. Authorized Official

Name: PATRICIA BAILEY
Title or Position: CO-OWNER
Credential: BCBA LBA
Phone: 703-862-1690