Healthcare Provider Details

I. General information

NPI: 1972932895
Provider Name (Legal Business Name): SPECTRUM OF DISORDERS: CONSULTING AND TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MOUNTAIN PASS RD
BLUE RIDGE VA
24064-1404
US

IV. Provider business mailing address

PO BOX 952
BLUE RIDGE VA
24064-0952
US

V. Phone/Fax

Practice location:
  • Phone: 540-676-7771
  • Fax: 540-728-9370
Mailing address:
  • Phone: 540-676-7771
  • Fax: 540-728-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. NAOMI S ROCK
Title or Position: EDUCATION CONSULTANT
Credential: PHD
Phone: 540-676-7771