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General NPI Number Information
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NPI Number | 1598366171
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Entity Type | Organization
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Legal Business Name | NEURODIVERSE ABILITY SERVICES LLC
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 608 SW MARVIN BURNETT RD
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City | LAKE CITY
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State | FL
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Zip | 32025-4918
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Country | US
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Telephone | 386-965-5197
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Fax |
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Provider Business Mailing Address
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Address Line | 664 SW MAULDIN AVE
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City | LAKE CITY
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State | FL
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Zip | 32024-4791
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Country | US
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Telephone | 386-965-5197
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. PAULA LYNETTE MILLER
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Credential | PH.D
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Telephone | 386-965-5197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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