Provider Demographics
NPI:1184405268
Name:LEARN & BLOSSOM ABA THERAPY
Entity type:Organization
Organization Name:LEARN & BLOSSOM ABA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAKIA
Authorized Official - Middle Name:NADIRA
Authorized Official - Last Name:ALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:828-380-1246
Mailing Address - Street 1:2023 BIG HOUSE GAINES BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4610
Mailing Address - Country:US
Mailing Address - Phone:828-380-1246
Mailing Address - Fax:
Practice Address - Street 1:2023 BIG HOUSE GAINES BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4610
Practice Address - Country:US
Practice Address - Phone:828-380-1246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty