Provider Demographics
NPI:1083352843
Name:SIGNATURE BEHAVIOR ANALYTIC SERVICES, LLC
Entity Type:Organization
Organization Name:SIGNATURE BEHAVIOR ANALYTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GINGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-304-8595
Mailing Address - Street 1:7001 JOHNNYCAKE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2419
Mailing Address - Country:US
Mailing Address - Phone:410-774-9840
Mailing Address - Fax:
Practice Address - Street 1:7001 JOHNNYCAKE RD STE 106
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2419
Practice Address - Country:US
Practice Address - Phone:410-774-9840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health