Provider Demographics
NPI:1144857764
Name:COMMON THREAD ABA LLC
Entity type:Organization
Organization Name:COMMON THREAD ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:STORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-612-8469
Mailing Address - Street 1:2004 AMERICAN WAY STE 109
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5892
Mailing Address - Country:US
Mailing Address - Phone:423-612-8469
Mailing Address - Fax:833-540-3751
Practice Address - Street 1:2004 AMERICAN WAY STE 109
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5892
Practice Address - Country:US
Practice Address - Phone:423-612-8469
Practice Address - Fax:833-540-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty