Provider Demographics
NPI:1730876954
Name:ADVANCED BEHAVIORAL DIMENSIONS, LLC
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL DIMENSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZENAYDA
Authorized Official - Middle Name:ANYLOU
Authorized Official - Last Name:LA FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-447-0022
Mailing Address - Street 1:9241 SW 212TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3833
Mailing Address - Country:US
Mailing Address - Phone:786-447-0022
Mailing Address - Fax:305-397-2764
Practice Address - Street 1:270 SHOALS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-1352
Practice Address - Country:US
Practice Address - Phone:786-447-0022
Practice Address - Fax:305-397-2764
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED BEHAVIORAL DIMENSIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty