Provider Demographics
NPI:1942025978
Name:KIDS CLUB ABA VA LLC
Entity type:Organization
Organization Name:KIDS CLUB ABA VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOISHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-458-0809
Mailing Address - Street 1:289 S CULVER ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4805
Mailing Address - Country:US
Mailing Address - Phone:404-458-0809
Mailing Address - Fax:404-834-5607
Practice Address - Street 1:8000 TOWERS CRESCENT DR FL 13
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-6211
Practice Address - Country:US
Practice Address - Phone:404-458-0809
Practice Address - Fax:404-834-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty