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General NPI Number Information
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NPI Number | 1912562281
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Entity Type | Organization
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Legal Business Name | LEARNING MY WAY ABA, LLC
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 1572 TIMBER TRACE DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-0757
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Country | US
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Telephone | 904-217-9531
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Fax |
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Provider Business Mailing Address
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Address Line | 1572 TIMBER TRACE DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-0757
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Country | US
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Telephone | 904-217-9531
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. MARCEL DOUGLAS LAWRENCE
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Credential |
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Telephone | 904-217-9531
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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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