Provider Demographics
NPI:1477027605
Name:POSITIVE VIBES ABA, LLC
Entity Type:Organization
Organization Name:POSITIVE VIBES ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:423-375-9192
Mailing Address - Street 1:1657 E STONE DR STE B #151
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4669
Mailing Address - Country:US
Mailing Address - Phone:423-375-9192
Mailing Address - Fax:
Practice Address - Street 1:1657 E STONE DR STE B
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4669
Practice Address - Country:US
Practice Address - Phone:423-375-9192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045695Medicaid
TNQ034863Medicaid