Provider Demographics
NPI:1235521220
Name:SELFACTUALIZEYOURSELF INC.
Entity Type:Organization
Organization Name:SELFACTUALIZEYOURSELF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINOV
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:754-214-3506
Mailing Address - Street 1:500 NE 12TH AVE
Mailing Address - Street 2:APT 708
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3638
Mailing Address - Country:US
Mailing Address - Phone:754-214-3506
Mailing Address - Fax:
Practice Address - Street 1:500 NE 12TH AVE
Practice Address - Street 2:APT 708
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3638
Practice Address - Country:US
Practice Address - Phone:754-214-3506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-11481103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty