Provider Demographics
NPI:1952110165
Name:SHAPING MINDS ABA LLC
Entity type:Organization
Organization Name:SHAPING MINDS ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEJA
Authorized Official - Middle Name:LANAE
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:770-626-5989
Mailing Address - Street 1:2500 DALLAS HIGHWAY
Mailing Address - Street 2:SUITE 202 #1116
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 DALLAS HIGHWAY
Practice Address - Street 2:SUITE 202 #1116
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064
Practice Address - Country:US
Practice Address - Phone:770-626-5989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty