Healthcare Provider Details

I. General information

NPI: 1932067782
Provider Name (Legal Business Name): IMPACT ABA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BREEZY LN
HARDEEVILLE SC
29927-8501
US

IV. Provider business mailing address

18 BREEZY LN
HARDEEVILLE SC
29927-8501
US

V. Phone/Fax

Practice location:
  • Phone: 912-677-4292
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MARQUERITE SIMPSON
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 703-870-9141