Provider Demographics
NPI: | 1508277385 |
---|---|
Name: | ABC CONSULTING LLC |
Entity Type: | Organization |
Organization Name: | ABC CONSULTING LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHARON |
Authorized Official - Middle Name: | LORENE |
Authorized Official - Last Name: | HOLBERT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MA, BCBA |
Authorized Official - Phone: | 304-319-2282 |
Mailing Address - Street 1: | 3309 DARRAH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | MORGANTOWN |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 26508-9187 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 304-319-2282 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 827 FAIRMONT RD |
Practice Address - Street 2: | SUITE 207 |
Practice Address - City: | MORGANTOWN |
Practice Address - State: | WV |
Practice Address - Zip Code: | 26501-3857 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-319-2282 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-05-14 |
Last Update Date: | 2014-05-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 1-11-8117 | 103K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty |