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General NPI Number Information
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NPI Number | 1285394601
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Entity Type | Organization
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Legal Business Name | CANVAS ABA, LLC
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 14886 US HIGHWAY 17
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City | HAMPSTEAD
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State | NC
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Zip | 28443-3217
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Country | US
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Telephone | 910-746-7187
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Fax |
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Provider Business Mailing Address
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Address Line | 770 HIGHLANDS DR
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City | HAMPSTEAD
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State | NC
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Zip | 28443-7438
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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 | KAYLA ZAMBRON
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Credential | M.A., BCBA, LBA
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Telephone | 910-746-7187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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