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General NPI Number Information
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NPI Number | 1942025978
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Entity Type | Organization
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Legal Business Name | KIDS CLUB ABA VA LLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 8000 TOWERS CRESCENT DR FL 13
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City | VIENNA
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State | VA
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Zip | 22182-6211
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Country | US
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Telephone | 404-458-0809
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Fax | 404-834-5607
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Provider Business Mailing Address
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Address Line | 289 S CULVER ST
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4805
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Country | US
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Telephone | 404-458-0809
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Fax | 404-834-5607
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Authorized Official
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Title or Position | CEO
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Name | MR. MOISHE BOBKER
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Credential |
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Telephone | 404-458-0809
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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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