Provider Demographics
NPI:1619716206
Name:ADVANCEABLE VA ABA LLC
Entity type:Organization
Organization Name:ADVANCEABLE VA ABA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:948-222-4968
Mailing Address - Street 1:1007 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1246
Mailing Address - Country:US
Mailing Address - Phone:948-222-4968
Mailing Address - Fax:804-710-2054
Practice Address - Street 1:303 HOLMAN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:948-222-4968
Practice Address - Fax:804-710-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty