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General NPI Number Information
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NPI Number | 1821894205
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE ABA
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 7817 SW 57TH LN APT 273
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City | GAINESVILLE
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State | FL
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Zip | 32608-4989
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Country | US
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Telephone | 301-655-0832
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Fax |
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Provider Business Mailing Address
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Address Line | 3021 BERKS WAY STE 101
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City | RALEIGH
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State | NC
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Zip | 27614-6775
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | ERIK BUSTAMANTE
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Credential | BCBA
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Telephone | 301-655-0832
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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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