Healthcare Provider Details

I. General information

NPI: 1124964812
Provider Name (Legal Business Name): AUTISM CIRCLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 RAINBOW CT
EDGEWOOD MD
21040-2333
US

IV. Provider business mailing address

703 RAINBOW CT
EDGEWOOD MD
21040-2333
US

V. Phone/Fax

Practice location:
  • Phone: 240-274-8822
  • Fax:
Mailing address:
  • Phone: 240-274-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: IKECHUKWU STANLEY OJIEGBE
Title or Position: DIRECTOR
Credential:
Phone: 240-274-8822