Provider Demographics
NPI:1306461439
Name:LUKES ABA
Entity type:Organization
Organization Name:LUKES ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QASP-S / REGISTERED BEHAVIOR TECH
Authorized Official - Prefix:MS
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH-BREEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-414-9736
Mailing Address - Street 1:525 WILLOW BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-9703
Mailing Address - Country:US
Mailing Address - Phone:609-414-9736
Mailing Address - Fax:919-375-5044
Practice Address - Street 1:525 WILLOW BREEZE CT
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-9703
Practice Address - Country:US
Practice Address - Phone:609-414-9736
Practice Address - Fax:919-375-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty