Provider Demographics
NPI:1710419528
Name:ABA INSIGHT, LLC
Entity Type:Organization
Organization Name:ABA INSIGHT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FUQUA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:734-972-2550
Mailing Address - Street 1:6267 WEBSTER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9659
Mailing Address - Country:US
Mailing Address - Phone:734-972-2550
Mailing Address - Fax:
Practice Address - Street 1:6267 WEBSTER CHURCH RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9659
Practice Address - Country:US
Practice Address - Phone:734-972-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11313269320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities