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General NPI Number Information
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NPI Number | 1902491343
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL SPECTRUM CARE ATL, LLC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 377 MAIN ST 2ND FL
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City | WEST HAVEN
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State | CT
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Zip | 06516
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Country | US
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Telephone | 203-889-7338
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Fax |
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Provider Business Mailing Address
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Address Line | 55 PROSPECT AVE
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City | WEST HAVEN
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State | CT
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Zip | 06516-6447
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Country | US
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Telephone | 203-889-7338
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SAMANTHA SEK
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Credential |
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Telephone | 203-889-7338
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 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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