Provider Demographics
NPI:1912587585
Name:DOM ABA SERVICES LLC
Entity Type:Organization
Organization Name:DOM ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:757-895-2673
Mailing Address - Street 1:611 STATION SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0705
Mailing Address - Country:US
Mailing Address - Phone:757-895-2673
Mailing Address - Fax:
Practice Address - Street 1:611 STATION SQUARE CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0705
Practice Address - Country:US
Practice Address - Phone:757-752-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty