Healthcare Provider Details

I. General information

NPI: 1518701655
Provider Name (Legal Business Name): SPRING FORWARD ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 WESTSIDE BLVD NW # 1
ROANOKE VA
24017-6784
US

IV. Provider business mailing address

12 BARNEGAT LN
JACKSON NJ
08527-3229
US

V. Phone/Fax

Practice location:
  • Phone: 540-598-7260
  • 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: MEIR WISE
Title or Position: OWNER
Credential:
Phone: 540-598-7260