Provider Demographics
NPI:1902638711
Name:DREAM LIGHT ABA LLC
Entity type:Organization
Organization Name:DREAM LIGHT ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-631-4588
Mailing Address - Street 1:948 JORICK CT E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8312
Mailing Address - Country:US
Mailing Address - Phone:561-631-4588
Mailing Address - Fax:
Practice Address - Street 1:948 JORICK CT E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8312
Practice Address - Country:US
Practice Address - Phone:561-631-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty