Provider Demographics
NPI:1114737731
Name:EARLY VICTORIES ABA LLC
Entity type:Organization
Organization Name:EARLY VICTORIES ABA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-583-8015
Mailing Address - Street 1:144 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9509
Mailing Address - Country:US
Mailing Address - Phone:760-583-8015
Mailing Address - Fax:
Practice Address - Street 1:144 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-9509
Practice Address - Country:US
Practice Address - Phone:760-583-8015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty