| Blaze Aba, Llc | |
|
30192 Armenia Rd Leesburg FL 34748-8454 | |
| (239) 465-8663 | |
| Not Available |
| Full Name | Blaze Aba, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 30192 Armenia Rd, Leesburg, Florida |
| Authorized Official Name and Position | Dawenn Dorgile (OWNER/BCBA) |
| Authorized Official Contact | 2394658663 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blaze Aba, Llc 30192 Armenia Rd Leesburg FL 34748-8454 Ph: (239) 465-8663 | Blaze Aba, Llc 30192 Armenia Rd Leesburg FL 34748-8454 Ph: (239) 465-8663 |
| NPI Number | 1932935079 |
|---|---|
| Provider Enumeration Date | 09/13/2024 |
| Last Update Date | 09/13/2024 |
| Certification Date | 09/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932935079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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