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NPI Code Detail

MEDICARE: AUTISM CONSULTING AND THERAPY, LLC

MEDICARE: AUTISM CONSULTING AND THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1134352792
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTISM CONSULTING AND THERAPY, LLC
Provider Business Mailing Address
First Line : 4520 HOLLAND OFFICE PARK
Second Line : SUITE 415
City : VIRGINIA BEACH
State : VA
Zip : 23452-1145
Country : US
Telephone Number : 757-639-2218
Fax Number :
Provider Business Practice Location Address
First Line : 3101 MAGIC HOLLOW BLVD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23453-3010
Country : US
Telephone Number : 757-639-2218
Fax Number : 866-594-3899
Authorized Official
Title or Position : PRESIDENT
Name : REBECCA MCGLOHN
Credential : BCBA
Telephone Number : 757-639-2218
Provider Enumeration Date : 08/31/2009
Last Update Date : 07/14/2020

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