Organization
BLUE GEMS ABA NC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID WOLF (CEO)
(617) 297-7998
Entity
Organization
Contact information
Practice address
615 SAINT GEORGE SQUARE CT, WINSTON SALEM, NC 27103-1356
(336) 827-3384
(617) 340-3371
Mailing address
615 SAINT GEORGE SQUARE CT, WINSTON SALEM, NC 27103-1356
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/24/2021
Last updated
06/05/2026
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