Provider Demographics
NPI:1407468879
Name:TRIANGLE ABA LLC
Entity Type:Organization
Organization Name:TRIANGLE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:NELMS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-310-5195
Mailing Address - Street 1:3604 NORWAY CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8753
Mailing Address - Country:US
Mailing Address - Phone:561-310-5195
Mailing Address - Fax:919-516-0163
Practice Address - Street 1:1600 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1639
Practice Address - Country:US
Practice Address - Phone:561-310-5195
Practice Address - Fax:919-504-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487832440OtherNPI
FL1962895052Medicaid
103TC0700XOtherTAXONOMY CODE