Provider Demographics
NPI:1487547360
Name:ICONIC ABA LLC
Entity type:Organization
Organization Name:ICONIC ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:ASHKAR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:626-688-7149
Mailing Address - Street 1:1921 PORT ROYAL RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4129
Mailing Address - Country:US
Mailing Address - Phone:626-688-7149
Mailing Address - Fax:
Practice Address - Street 1:1921 PORT ROYAL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4129
Practice Address - Country:US
Practice Address - Phone:626-688-7149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty