Provider Demographics
NPI:1235950908
Name:ELEVATED MINDS ABA LLC
Entity type:Organization
Organization Name:ELEVATED MINDS ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DASYAE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:410-916-2936
Mailing Address - Street 1:3801 US HWY 17 STE 500
Mailing Address - Street 2:#1045
Mailing Address - City:RICHMONDHILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:410-916-2936
Mailing Address - Fax:
Practice Address - Street 1:3801 US HWY 17 STE 500
Practice Address - Street 2:#1045
Practice Address - City:RICHMONDHILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-572-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician