Healthcare Provider Details

I. General information

NPI: 1790490753
Provider Name (Legal Business Name): ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 3RD ST STE 11
WINSTON SALEM NC
27101-3940
US

IV. Provider business mailing address

102 W 3RD ST STE 11
WINSTON SALEM NC
27101-3940
US

V. Phone/Fax

Practice location:
  • Phone: 305-417-2657
  • Fax: 855-656-9641
Mailing address:
  • Phone:
  • Fax: 855-656-9641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEJANDRO WERNER
Title or Position: CEO
Credential: BCBA
Phone: 305-417-2657