Provider Demographics
NPI:1063241420
Name:BEAUTIFUL HEARTS ABA, LLC
Entity type:Organization
Organization Name:BEAUTIFUL HEARTS ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:252-506-3556
Mailing Address - Street 1:210 HARMON RD
Mailing Address - Street 2:#1052
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284
Mailing Address - Country:US
Mailing Address - Phone:252-506-3556
Mailing Address - Fax:
Practice Address - Street 1:210 HARMON RD
Practice Address - Street 2:#1052
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:252-506-3556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty