Provider Demographics
NPI:1558037507
Name:UPWARD AUTISM CENTER LLC
Entity Type:Organization
Organization Name:UPWARD AUTISM CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CENTER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:502-338-4266
Mailing Address - Street 1:4400 BROWNSVILLE RD STE #105 #3080
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8902
Mailing Address - Country:US
Mailing Address - Phone:470-333-2051
Mailing Address - Fax:678-669-2694
Practice Address - Street 1:4400 BROWNSVILLE RD STE #105 #3080
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8902
Practice Address - Country:US
Practice Address - Phone:470-333-2051
Practice Address - Fax:678-669-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1-18-32530OtherBCBA CERTIFICATE