=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376333252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOAH'S ARK ABA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2025
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 STEEPLE CHASE DR STE 106
-----------------------------------------------------
City | PRINCE FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20678-4053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-999-4718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 HARVESTER LN
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30518-3274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-999-4718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VIRGINIA ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-999-4718
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------