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General NPI Number Information
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NPI Number | 1326883521
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Entity Type | Organization
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Legal Business Name | MOUNTAIN WAVES ABA, LLC
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Dates
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Enumeration Date | 06/28/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 6746 THIRLANE RD
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City | ROANOKE
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State | VA
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Zip | 24019-2908
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Country | US
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Telephone | 540-915-4767
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Fax | 540-202-9002
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Provider Business Mailing Address
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Address Line | 730 CAMP NORTH RD
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City | SALEM
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State | VA
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Zip | 24153-3046
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Country | US
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Telephone | 540-915-4767
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Fax | 540-202-9002
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Authorized Official
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Title or Position | OWNER
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Name | ABIGAIL ERIN HARD
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Credential | BCBA
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Telephone | 540-915-4767
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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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