Provider Demographics
NPI:1649806803
Name:LITTLE STARS ABA THERAPY AND COUNSELING CENTER
Entity type:Organization
Organization Name:LITTLE STARS ABA THERAPY AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINCENTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LMFT BCBA-D LBS
Authorized Official - Phone:607-760-9520
Mailing Address - Street 1:153 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-9600
Mailing Address - Country:US
Mailing Address - Phone:607-760-9520
Mailing Address - Fax:
Practice Address - Street 1:203 S ELMER AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2019
Practice Address - Country:US
Practice Address - Phone:607-760-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health