Provider Demographics
NPI:1073359857
Name:ABODE ABA
Entity type:Organization
Organization Name:ABODE ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-360-1116
Mailing Address - Street 1:301 S MCDOWELL ST STE 125-1027
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2623
Mailing Address - Country:US
Mailing Address - Phone:980-288-5692
Mailing Address - Fax:
Practice Address - Street 1:301 S MCDOWELL ST STE 125-1027
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2623
Practice Address - Country:US
Practice Address - Phone:980-288-5692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty