Provider Demographics
NPI:1578177168
Name:DESTINED FOR DIGNITY ABA LLC
Entity Type:Organization
Organization Name:DESTINED FOR DIGNITY ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMENAGHAWON
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-400-9043
Mailing Address - Street 1:1601 MERKLEY AVE UNIT 656
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-7727
Mailing Address - Country:US
Mailing Address - Phone:916-400-9043
Mailing Address - Fax:
Practice Address - Street 1:3660 COYOTE RD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-5465
Practice Address - Country:US
Practice Address - Phone:530-204-8735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty