Provider Demographics
NPI:1790375335
Name:SUCCESSFUL CHILD ABA THERAPY, LLC
Entity Type:Organization
Organization Name:SUCCESSFUL CHILD ABA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARLER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:910-939-9986
Mailing Address - Street 1:304 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8341
Mailing Address - Country:US
Mailing Address - Phone:910-939-9986
Mailing Address - Fax:910-460-3967
Practice Address - Street 1:304 WELLINGTON PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-8341
Practice Address - Country:US
Practice Address - Phone:910-939-9986
Practice Address - Fax:910-460-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty