Provider Demographics
NPI:1083122295
Name:ANCHORS AWEIGH ABA LLC
Entity Type:Organization
Organization Name:ANCHORS AWEIGH ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:757-572-1949
Mailing Address - Street 1:101 MARKETSIDE AVE STE 404-411
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-1541
Mailing Address - Country:US
Mailing Address - Phone:757-572-1949
Mailing Address - Fax:
Practice Address - Street 1:574 OUTLOOK DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0780
Practice Address - Country:US
Practice Address - Phone:757-572-1949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty