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General NPI Number Information
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NPI Number | 1073311569
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL CONCEPTS LLC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 4050 SOUTHWOOD CIR SW UNIT 1104
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City | ATLANTA
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State | GA
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Zip | 30331-8818
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Country | US
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Telephone | 910-709-3487
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Fax |
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Provider Business Mailing Address
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Address Line | 6946 SKYHAWK DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5381
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Country | US
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Telephone | 336-212-9236
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ETERNIA RICHMOND
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Credential |
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Telephone | 910-709-3487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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