MEDICARE: THRIVE ABA CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0133000315	VA

General Provider Information

NPI Number	:	1114331071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE ABA CONSULTING LLC

Provider Business Mailing Address
First Line	:	120 BOWERY ST
Second Line	:	#308
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BOWERY ST
Second Line	:	#308
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3756
Country	:	US
Telephone Number	:	843-714-4266
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ZACK MIGIOIA
Credential	:
Telephone Number	:	843-714-4266

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	06/18/2014

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