Provider Demographics
NPI:1295413904
Name:LUMI ABA LLC
Entity type:Organization
Organization Name:LUMI ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DESTINEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:404-388-2190
Mailing Address - Street 1:100 POSTMASTER DR UNIT 786
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-2808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 KEYTON DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1924
Practice Address - Country:US
Practice Address - Phone:404-388-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty