Provider Demographics
NPI:1003455205
Name:MANAGING OVERWHELMING MOMENTS, LLC
Entity Type:Organization
Organization Name:MANAGING OVERWHELMING MOMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-448-4054
Mailing Address - Street 1:1119 STAFFORD PLACE CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6886
Mailing Address - Country:US
Mailing Address - Phone:919-218-6286
Mailing Address - Fax:
Practice Address - Street 1:1119 STAFFORD PLACE CIR APT 103
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6886
Practice Address - Country:US
Practice Address - Phone:919-218-6286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty