Provider Demographics
NPI:1669800876
Name:BUTTERFLY EFFECTS
Entity type:Organization
Organization Name:BUTTERFLY EFFECTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR IMPLEMENTER
Authorized Official - Prefix:
Authorized Official - First Name:LASWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-903-7839
Mailing Address - Street 1:6061 TINA LN
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4301 N FEDERAL HWY STE 2
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6519
Practice Address - Country:US
Practice Address - Phone:888-870-9207
Practice Address - Fax:954-342-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty