Provider Demographics
NPI:1124524194
Name:CAROLINA ABA
Entity type:Organization
Organization Name:CAROLINA ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:803-504-4861
Mailing Address - Street 1:420 HERLONG AVE S STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1091
Mailing Address - Country:US
Mailing Address - Phone:803-328-0587
Mailing Address - Fax:888-500-7047
Practice Address - Street 1:420 HERLONG AVE S STE 104
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1091
Practice Address - Country:US
Practice Address - Phone:803-328-0587
Practice Address - Fax:888-500-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty