Provider Demographics
NPI:1518469220
Name:ZOE CENTER FOR ABA AND DEVELOPMENT SERVICES, LLC
Entity Type:Organization
Organization Name:ZOE CENTER FOR ABA AND DEVELOPMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SMITH-KONG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:888-963-2228
Mailing Address - Street 1:1110 13TH STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901
Mailing Address - Country:US
Mailing Address - Phone:888-963-2228
Mailing Address - Fax:706-780-1705
Practice Address - Street 1:1110 13TH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:888-963-2228
Practice Address - Fax:706-780-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 2080P0006X
GA393882080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA956718471Medicaid