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General NPI Number Information
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NPI Number | 1588994859
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Entity Type | Organization
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Legal Business Name | JAWANDA NEWSOME ABA AND BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 1027 WINDY POND
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City | SAN ANTONIO
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State | TX
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Zip | 78260-2596
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Country | US
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Telephone | 210-885-3481
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Fax | 210-858-3853
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Provider Business Mailing Address
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Address Line | 1027 WINDY POND
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City | SAN ANTONIO
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State | TX
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Zip | 78260-2596
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Country | US
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Telephone | 210-885-3481
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Fax | 210-858-3853
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JAWANDA CORBIN-NEWSOME
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Credential | BCBA
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Telephone | 210-885-3481
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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 | 1-07-3487
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License Number State | TX
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