Provider Demographics
NPI:1588247415
Name:ABA DIRECT LLC
Entity type:Organization
Organization Name:ABA DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:THORBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:646-420-6837
Mailing Address - Street 1:2924 TWO LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8208
Mailing Address - Country:US
Mailing Address - Phone:646-420-6837
Mailing Address - Fax:
Practice Address - Street 1:2924 TWO LAKE CIR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8208
Practice Address - Country:US
Practice Address - Phone:646-420-6837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty