Provider Demographics
NPI:1720408883
Name:NEUROBEHAVIORAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL ASSOCIATES LLC
Other - Org Name:NBA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-823-5275
Mailing Address - Street 1:639 13TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1007
Mailing Address - Country:US
Mailing Address - Phone:706-823-5250
Mailing Address - Fax:706-823-5266
Practice Address - Street 1:639 13TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1007
Practice Address - Country:US
Practice Address - Phone:706-823-5250
Practice Address - Fax:706-823-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004950103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty