Provider Demographics
NPI:1740953140
Name:ABASCAPE LLC
Entity type:Organization
Organization Name:ABASCAPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:706-691-4729
Mailing Address - Street 1:2171 FOSTER SPROUSE RD
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-6918
Mailing Address - Country:US
Mailing Address - Phone:706-691-4729
Mailing Address - Fax:706-843-6294
Practice Address - Street 1:3633 WHEELER RD STE 320
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6552
Practice Address - Country:US
Practice Address - Phone:706-691-4729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty