Provider Demographics
NPI:1437701844
Name:FATAJ TRANSITION & LEARNING CENTER, LLC
Entity Type:Organization
Organization Name:FATAJ TRANSITION & LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:248-910-0440
Mailing Address - Street 1:16591 WINGSPREAD LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9493
Mailing Address - Country:US
Mailing Address - Phone:248-910-0440
Mailing Address - Fax:
Practice Address - Street 1:16591 WINGSPREAD LOOP
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9493
Practice Address - Country:US
Practice Address - Phone:407-680-8957
Practice Address - Fax:407-395-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty