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General NPI Number Information
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NPI Number | 1578177168
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Entity Type | Organization
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Legal Business Name | DESTINED FOR DIGNITY ABA LLC
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 3660 COYOTE RD
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-5465
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Country | US
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Telephone | 530-204-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 MERKLEY AVE UNIT 656
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-7727
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Country | US
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Telephone | 916-400-9043
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/CEO
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Name | AMENAGHAWON AHMAD
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Credential |
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Telephone | 916-400-9043
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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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