1730566100 NPI number — LITTLE STEPS BIG LEAPS, LLC Kimberly Sakrison LBA, BCBA

Table of content: Kimberly Sakrison LBA, BCBA (NPI 1730566100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730566100 NPI number — LITTLE STEPS BIG LEAPS, LLC Kimberly Sakrison LBA, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE STEPS BIG LEAPS, LLC
Provider Last Name:
Sakrison
Provider First Name:
Kimberly
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LBA, BCBA
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730566100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 Academy Road
Provider Second Line Business Mailing Address:
Suite 200
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
984-365-9330
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 Academy Road
Provider Second Line Business Practice Location Address:
Suite 200
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-365-9330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JANSSEN
Authorized Official First Name:
MAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE SUPERVISIOR
Authorized Official Telephone Number:
765-628-7400

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  342 , registered in the state of North Carolina ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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