Organization
A LEAP BEYOND AUTISM SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIA CHALISE PENN-TABOR (CEO)
(404) 966-3933
Entity
Organization
Contact information
Practice address
110 NEWFIELD DR, TYRONE, GA 30290-2567
(678) 862-6226
Mailing address
100 COMMERCE DR UNIT 452, TYRONE, GA 30290-8020
(404) 966-3933
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8837997616
—
GA
Enumeration date
06/08/2021
Last updated
10/06/2022
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