Organization
SUPPORTIVE CARE ABA NC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUBEN KESHERIM (MEMBER)
(317) 936-1240
Entity
Organization
Contact information
Practice address
104 S WHITE ST STE 150, WAKE FOREST, NC 27587-2773
(317) 936-1240
Mailing address
104 S WHITE ST STE 150, WAKE FOREST, NC 27587-2773
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/22/2022
Last updated
10/17/2023
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