MEDICARE: BLOOMING FORWARD ABA 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1801752134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMING FORWARD ABA LLC

Provider Business Mailing Address
First Line	:	650 FULLIER CIR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-7993
Country	:	US
Telephone Number	:	404-664-9406
Fax Number	:	404-664-9406

Provider Business Practice Location Address
First Line	:	650 FULLIER CIR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-7993
Country	:	US
Telephone Number	:	404-664-9406
Fax Number	:

Authorized Official
Title or Position	:	BOARD T CERTIFIED BEHAVIOR AN
Name	:	EQUENCE BYNUM
Credential	:	BCBA
Telephone Number	:	404-664-9406

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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Directions to “BLOOMING FORWARD ABA LLC ” Practice Location

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