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General NPI Number Information
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NPI Number | 1235769209
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Entity Type | Organization
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Legal Business Name | ABC BEHAVIORAL THERAPY
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Dates
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Enumeration Date | 01/18/2020
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 816 TANGLEWOOD CIR
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City | DUBLIN
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State | GA
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Zip | 31021-1022
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Country | US
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Telephone | 478-279-7214
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Fax | 833-478-1298
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Provider Business Mailing Address
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Address Line | 816 TANGLEWOOD CIR
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City | DUBLIN
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State | GA
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Zip | 31021-1022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES DUSTIN WOOD
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Credential | CPA
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Telephone | 478-278-9766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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