Provider Demographics
NPI:1982151338
Name:POSITIVE STRIDES LLC
Entity Type:Organization
Organization Name:POSITIVE STRIDES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:AISHAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOODRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-472-8964
Mailing Address - Street 1:10139 BEACH PORT DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4413
Mailing Address - Country:US
Mailing Address - Phone:678-472-8964
Mailing Address - Fax:404-487-8907
Practice Address - Street 1:10139 BEACH PORT DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4413
Practice Address - Country:US
Practice Address - Phone:678-472-8964
Practice Address - Fax:404-487-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty